Provider Demographics
NPI:1174216766
Name:CARR, RAVEN LAKEISHA (MS, CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:LAKEISHA
Last Name:CARR
Suffix:
Gender:F
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3238
Mailing Address - Country:US
Mailing Address - Phone:504-240-8956
Mailing Address - Fax:
Practice Address - Street 1:3501 SEINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6704
Practice Address - Country:US
Practice Address - Phone:504-941-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8708235Z00000X
LA14360672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist