Provider Demographics
NPI:1558648204
Name:O'ROURKE, MANDI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 7168
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-0168
Mailing Address - Country:US
Mailing Address - Phone:910-494-8427
Mailing Address - Fax:
Practice Address - Street 1:8843 HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:GORUM
Practice Address - State:LA
Practice Address - Zip Code:71434
Practice Address - Country:US
Practice Address - Phone:910-494-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist