Provider Demographics
NPI:1477206548
Name:CREATIVE CONNECTIONS PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:CREATIVE CONNECTIONS PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:FRASIER
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:318-267-6944
Mailing Address - Street 1:162 CREEKS XING
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1764
Mailing Address - Country:US
Mailing Address - Phone:318-267-6944
Mailing Address - Fax:
Practice Address - Street 1:162 CREEKS XING
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1764
Practice Address - Country:US
Practice Address - Phone:318-267-6944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty