Provider Demographics
NPI:1508141177
Name:SMALL, LETRICE WILLIAMS (MEDL-SLP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LETRICE
Middle Name:WILLIAMS
Last Name:SMALL
Suffix:
Gender:F
Credentials:MEDL-SLP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 BRADFORD PL
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-1423
Mailing Address - Country:US
Mailing Address - Phone:504-858-4722
Mailing Address - Fax:504-368-5999
Practice Address - Street 1:1912 BRADFORD PL
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-1423
Practice Address - Country:US
Practice Address - Phone:504-858-4722
Practice Address - Fax:504-368-5999
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3696235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist