Provider Demographics
NPI:1881849479
Name:DETILLIER, HEIDI DUFRENE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:DUFRENE
Last Name:DETILLIER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-2739
Mailing Address - Country:US
Mailing Address - Phone:985-209-2168
Mailing Address - Fax:
Practice Address - Street 1:250 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-2739
Practice Address - Country:US
Practice Address - Phone:985-209-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5809235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist