Provider Demographics
NPI:1629598537
Name:WASHINGTON, KESHLA (SLP-A)
Entity Type:Individual
Prefix:
First Name:KESHLA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36505 OAK PLZ STE B
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3198
Mailing Address - Country:US
Mailing Address - Phone:225-402-4466
Mailing Address - Fax:225-402-4467
Practice Address - Street 1:36505 OAK PLAZA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769
Practice Address - Country:US
Practice Address - Phone:225-402-4466
Practice Address - Fax:225-402-4467
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty