Provider Demographics
NPI:1164911228
Name:LAROSE, MEGAN SMITH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SMITH
Last Name:LAROSE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:PAISLEY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:352 SUGAR HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8343
Mailing Address - Country:US
Mailing Address - Phone:954-529-1376
Mailing Address - Fax:
Practice Address - Street 1:1979 LAKESIDE PKWY STE 800
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5856
Practice Address - Country:US
Practice Address - Phone:678-497-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2022-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001330235Z00000X
LA8095235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist