Provider Demographics
NPI:1851555387
Name:BYRNE, CONNIE OUSTALET (MS,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:OUSTALET
Last Name:BYRNE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VETERANS AVE
Mailing Address - Street 2:BLDG. 3, ROOM 2A100
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2410
Mailing Address - Country:US
Mailing Address - Phone:228-523-5486
Mailing Address - Fax:228-523-4518
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:BLDG. 3, ROOM 2A100
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5486
Practice Address - Fax:228-523-4518
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist