Provider Demographics
NPI:1528214152
Name:DELONG, CHARLES E (ST)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:DELONG
Suffix:
Gender:M
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29419 WALKER SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-7905
Mailing Address - Country:US
Mailing Address - Phone:225-665-8080
Mailing Address - Fax:225-665-0999
Practice Address - Street 1:29419 WALKER SOUTH RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7905
Practice Address - Country:US
Practice Address - Phone:225-665-8080
Practice Address - Fax:225-665-0999
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist