Provider Demographics
NPI:1942813647
Name:REID, ALLIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:REID
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 1:549 VERSAILLES BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2566
Mailing Address - Country:US
Mailing Address - Phone:601-754-9612
Mailing Address - Fax:
Practice Address - Street 1:4515 EDDIE WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3628
Practice Address - Country:US
Practice Address - Phone:601-754-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8975235Z00000X
MSS4693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist