Provider Demographics
NPI:1275713497
Name:HERRING, CHARLOTTE WRIGHT
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:WRIGHT
Last Name:HERRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:C-200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-227-9002
Mailing Address - Fax:318-227-9025
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:C-200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-227-9002
Practice Address - Fax:318-227-9025
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12084514235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist