Provider Demographics
NPI:1184851099
Name:DEBLANC LANDRY, JAYNE F (SLP, MCD)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:F
Last Name:DEBLANC LANDRY
Suffix:
Gender:F
Credentials:SLP, MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 SAINT ANN AVE
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-4646
Mailing Address - Country:US
Mailing Address - Phone:337-308-2239
Mailing Address - Fax:
Practice Address - Street 1:259 SAINT ANN AVE
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-4646
Practice Address - Country:US
Practice Address - Phone:337-308-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1473235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist