Provider Demographics
NPI:1164799250
Name:REEVES, LISA BROOKE (SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BROOKE
Last Name:REEVES
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 1:740 KEYSER AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6037
Mailing Address - Country:US
Mailing Address - Phone:318-214-0088
Mailing Address - Fax:318-214-9009
Practice Address - Street 1:740 KEYSER AVE.,
Practice Address - Street 2:SUITE E
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457
Practice Address - Country:US
Practice Address - Phone:318-214-0088
Practice Address - Fax:318-214-9009
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4732OtherSPEECH LANGUAGE PATHOLOGY