Provider Demographics
NPI:1629561949
Name:AUGUSTINE, DANELLE BLUE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DANELLE
Middle Name:BLUE
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18512 GARDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7556
Mailing Address - Country:US
Mailing Address - Phone:225-999-2583
Mailing Address - Fax:
Practice Address - Street 1:855 SHIRLEY RD
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-1540
Practice Address - Country:US
Practice Address - Phone:318-346-9288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist