Provider Demographics
NPI:1063854750
Name:LSU SPEECH, LANGUAGE AND HEARING CLINIC
Entity Type:Organization
Organization Name:LSU SPEECH, LANGUAGE AND HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUMONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-A
Authorized Official - Phone:225-578-9054
Mailing Address - Street 1:63 HATCHER HL
Mailing Address - Street 2:LSU DEPARTMENT OF COMMUNICATION SCIENCES AND DISORDERS
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70803-0001
Mailing Address - Country:US
Mailing Address - Phone:225-578-9054
Mailing Address - Fax:225-578-2995
Practice Address - Street 1:63 HATCHER HL
Practice Address - Street 2:LSU DEPARTMENT OF COMMUNICATION SCIENCES AND DISORDERS
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-0001
Practice Address - Country:US
Practice Address - Phone:225-578-9054
Practice Address - Fax:225-578-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2717231H00000X
LA5254235Z00000X
LA3473235Z00000X
LA4342235Z00000X
LA5440235Z00000X
LA1717235Z00000X
LA5845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty