Provider Demographics
NPI:1710270764
Name:TUCKER, FAYE TERREBONNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:FAYE
Middle Name:TERREBONNE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PUMA DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-8755
Mailing Address - Country:US
Mailing Address - Phone:318-397-5530
Mailing Address - Fax:
Practice Address - Street 1:1890 HUDSON CIR STE 4
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3545
Practice Address - Country:US
Practice Address - Phone:318-348-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist