Provider Demographics
NPI:1114516218
Name:SPEECH BUBBLE
Entity Type:Organization
Organization Name:SPEECH BUBBLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:LERCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:MCD/CCC-SLP
Authorized Official - Phone:318-518-0778
Mailing Address - Street 1:490 SOUTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8390
Mailing Address - Country:US
Mailing Address - Phone:318-518-0778
Mailing Address - Fax:
Practice Address - Street 1:490 SOUTHAVEN LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8390
Practice Address - Country:US
Practice Address - Phone:318-518-0778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1559644Medicaid