Provider Demographics
NPI:1801007976
Name:HARPER, AMY FONTENOT (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:FONTENOT
Last Name:HARPER
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 1:115 ST. JULIAN ST.
Mailing Address - Street 2:
Mailing Address - City:SCHRIEVER
Mailing Address - State:LA
Mailing Address - Zip Code:70395-0000
Mailing Address - Country:US
Mailing Address - Phone:985-859-1398
Mailing Address - Fax:
Practice Address - Street 1:115 ST. JULIAN ST.
Practice Address - Street 2:
Practice Address - City:SCHRIEVER
Practice Address - State:LA
Practice Address - Zip Code:70395-0000
Practice Address - Country:US
Practice Address - Phone:985-859-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1714305Medicaid