Provider Demographics
NPI:1245747310
Name:BROUSSARD, MORGAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:
Last Name:BROUSSARD
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 1:108 ENERGY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3818
Mailing Address - Country:US
Mailing Address - Phone:337-504-4244
Mailing Address - Fax:337-706-7612
Practice Address - Street 1:108 ENERGY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3818
Practice Address - Country:US
Practice Address - Phone:337-504-4244
Practice Address - Fax:337-706-7612
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist