Provider Demographics
NPI:1760504690
Name:SOLOMON, DENISE MARIE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6B RUE CHARDONNAY
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-5384
Mailing Address - Country:US
Mailing Address - Phone:504-466-8273
Mailing Address - Fax:
Practice Address - Street 1:2200 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4001
Practice Address - Country:US
Practice Address - Phone:504-461-4266
Practice Address - Fax:504-461-9976
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4854235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1313751Medicaid