Provider Demographics
NPI:1326476011
Name:ROQUES, MARY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:ROQUES
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 1:1054 CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4544
Mailing Address - Country:US
Mailing Address - Phone:985-665-7575
Mailing Address - Fax:800-861-7494
Practice Address - Street 1:1054 CANAL BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4544
Practice Address - Country:US
Practice Address - Phone:985-665-7575
Practice Address - Fax:800-861-7494
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1239235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist