Provider Demographics
NPI:1093229460
Name:WARREN, ASA PAUL (,MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:ASA
Middle Name:PAUL
Last Name:WARREN
Suffix:
Gender:M
Credentials:,MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HARDERS CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8557
Mailing Address - Country:US
Mailing Address - Phone:318-455-8227
Mailing Address - Fax:
Practice Address - Street 1:1961 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-2200
Practice Address - Country:US
Practice Address - Phone:318-603-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist