Provider Demographics
NPI:1053327395
Name:MIZE, MAURA CARMOUCHE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MAURA
Middle Name:CARMOUCHE
Last Name:MIZE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 PITHON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5245
Mailing Address - Country:US
Mailing Address - Phone:337-433-4212
Mailing Address - Fax:337-433-4234
Practice Address - Street 1:1130 PITHON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5245
Practice Address - Country:US
Practice Address - Phone:337-433-4212
Practice Address - Fax:337-433-4234
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist