Provider Demographics
NPI:1689991309
Name:SPEECH THERAPY SERVICES OF BATON ROUGE
Entity Type:Organization
Organization Name:SPEECH THERAPY SERVICES OF BATON ROUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PAHTHOLOGIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:TALLO
Authorized Official - Last Name:LALANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-281-3412
Mailing Address - Street 1:2644 WOODLAND RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2539
Mailing Address - Country:US
Mailing Address - Phone:225-281-3412
Mailing Address - Fax:
Practice Address - Street 1:2644 WOODLAND RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2539
Practice Address - Country:US
Practice Address - Phone:225-281-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2125524Medicaid