Provider Demographics
NPI:1407431851
Name:FEARN, JUSTIN (HIS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:FEARN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1779
Mailing Address - Country:US
Mailing Address - Phone:504-345-7668
Mailing Address - Fax:
Practice Address - Street 1:1216 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5702
Practice Address - Country:US
Practice Address - Phone:985-662-3042
Practice Address - Fax:985-662-3042
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0692237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist