Provider Demographics
NPI:1508404468
Name:DEVILLE, MAGGIE (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:DEVILLE
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12072 GRIFFITH RD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6478
Mailing Address - Country:US
Mailing Address - Phone:225-715-9745
Mailing Address - Fax:
Practice Address - Street 1:12072 GRIFFITH RD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6478
Practice Address - Country:US
Practice Address - Phone:225-715-9745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist