Provider Demographics
NPI:1821615469
Name:FONTENOT, MARY CLAIRE (MA, CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CLAIRE
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 ESSEN LN APT 74
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2180
Mailing Address - Country:US
Mailing Address - Phone:337-513-3977
Mailing Address - Fax:
Practice Address - Street 1:5930 GOODWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7307
Practice Address - Country:US
Practice Address - Phone:225-281-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist