Provider Demographics
NPI:1508043456
Name:LUELLEN, ANN ELLEN SR (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ELLEN
Last Name:LUELLEN
Suffix:SR
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 1:159 SANFORD LANE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1902
Mailing Address - Country:US
Mailing Address - Phone:318-396-7652
Mailing Address - Fax:318-396-9008
Practice Address - Street 1:159 SANFORD LANE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-1902
Practice Address - Country:US
Practice Address - Phone:318-396-7652
Practice Address - Fax:318-396-9008
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist