Provider Demographics
NPI:1235551326
Name:LIRETTE, JACKIE ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:ANN
Last Name:LIRETTE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-1233
Mailing Address - Country:US
Mailing Address - Phone:985-791-7034
Mailing Address - Fax:
Practice Address - Street 1:452 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1233
Practice Address - Country:US
Practice Address - Phone:985-791-7034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist