Provider Demographics
NPI:1326169525
Name:LAVIGNE, WINNIE SUE (MED,L-SLP,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:SUE
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:MED,L-SLP,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30048 PEAK LN
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-7109
Mailing Address - Country:US
Mailing Address - Phone:225-665-8173
Mailing Address - Fax:225-791-8593
Practice Address - Street 1:30048 PEAK LN
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7109
Practice Address - Country:US
Practice Address - Phone:225-665-8173
Practice Address - Fax:225-791-8593
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1308706Medicaid