Provider Demographics
NPI:1013942226
Name:WARNER, BRIAN D (SLP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:WARNER
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3015
Mailing Address - Country:US
Mailing Address - Phone:318-449-9221
Mailing Address - Fax:318-445-6697
Practice Address - Street 1:3912 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3015
Practice Address - Country:US
Practice Address - Phone:318-449-9221
Practice Address - Fax:318-445-6697
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3396842OtherAETNA PROVIDER #