Provider Demographics
NPI:1619261898
Name:FAZZIO, LOUISE BREAUX (SLP)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:BREAUX
Last Name:FAZZIO
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 1:526 S FRENCH QUARTER DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-2682
Mailing Address - Country:US
Mailing Address - Phone:985-223-1905
Mailing Address - Fax:
Practice Address - Street 1:526 S FRENCH QUARTER DR
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2682
Practice Address - Country:US
Practice Address - Phone:985-223-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist