Provider Demographics
NPI:1508069709
Name:KING, BARBARA (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:KING-HASTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5609 CROSS TIMBER DR.
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129
Mailing Address - Country:US
Mailing Address - Phone:504-491-5474
Mailing Address - Fax:
Practice Address - Street 1:5609 CROSS TIMBERS DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3605
Practice Address - Country:US
Practice Address - Phone:504-491-5474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1472565Medicaid