Provider Demographics
NPI:1568718864
Name:DEROCHE, DARA LYNN ELIZABETH (SLP)
Entity Type:Individual
Prefix:
First Name:DARA LYNN
Middle Name:ELIZABETH
Last Name:DEROCHE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SCHNELL DR
Mailing Address - Street 2:
Mailing Address - City:ARABI
Mailing Address - State:LA
Mailing Address - Zip Code:70032-1661
Mailing Address - Country:US
Mailing Address - Phone:504-982-1447
Mailing Address - Fax:
Practice Address - Street 1:1600 SCHNELL DR
Practice Address - Street 2:
Practice Address - City:ARABI
Practice Address - State:LA
Practice Address - Zip Code:70032-1661
Practice Address - Country:US
Practice Address - Phone:504-982-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist