Provider Demographics
NPI:1083809024
Name:DEROUSSELLE, EMMA D (SLP)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:D
Last Name:DEROUSSELLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-1326
Mailing Address - Country:US
Mailing Address - Phone:337-233-1721
Mailing Address - Fax:337-233-1721
Practice Address - Street 1:323 E ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1326
Practice Address - Country:US
Practice Address - Phone:337-233-1721
Practice Address - Fax:337-233-1721
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist