Provider Demographics
NPI:1568687614
Name:OPELOUSAS SPEECH AND HEARING CENTER
Entity Type:Organization
Organization Name:OPELOUSAS SPEECH AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST AND SPEECH PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:337-942-3451
Mailing Address - Street 1:318 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5246
Mailing Address - Country:US
Mailing Address - Phone:337-942-3451
Mailing Address - Fax:337-942-3414
Practice Address - Street 1:318 W NORTH ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5246
Practice Address - Country:US
Practice Address - Phone:337-942-3451
Practice Address - Fax:337-942-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA437769435AOtherAUDIOLOGIST
LA1969389Medicaid
LA4600002OtherAUDIOLOGIST
LA437769435AOtherAUDIOLOGIST