Provider Demographics
NPI:1710652508
Name:SOURS, DEVANNE BRANDI
Entity Type:Individual
Prefix:
First Name:DEVANNE
Middle Name:BRANDI
Last Name:SOURS
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 1:810 EUTERPE ST APT 9109
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-8626
Mailing Address - Country:US
Mailing Address - Phone:575-399-8831
Mailing Address - Fax:
Practice Address - Street 1:810 EUTERPE ST APT 9109
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-8626
Practice Address - Country:US
Practice Address - Phone:575-399-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist