Provider Demographics
NPI:1699411173
Name:FONTENOT, BLAIRE FUSILIER
Entity Type:Individual
Prefix:MRS
First Name:BLAIRE
Middle Name:FUSILIER
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 HARVEY LEBAS DR
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5352
Mailing Address - Country:US
Mailing Address - Phone:337-363-5502
Mailing Address - Fax:
Practice Address - Street 1:607 HARVEY LEBAS DR
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5352
Practice Address - Country:US
Practice Address - Phone:337-363-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist