Provider Demographics
NPI:1710765110
Name:TALLIA, BRINDLEY (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:BRINDLEY
Middle Name:
Last Name:TALLIA
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46213 N MORRISON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-1229
Mailing Address - Country:US
Mailing Address - Phone:985-320-0912
Mailing Address - Fax:
Practice Address - Street 1:59656 PULESTON RD
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-5616
Practice Address - Country:US
Practice Address - Phone:985-748-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8295235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist