Provider Demographics
NPI:1184112658
Name:LOUISIANA TECH SPEECH AND HEARING CENTER
Entity type:Organization
Organization Name:LOUISIANA TECH SPEECH AND HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:318-257-4764
Mailing Address - Street 1:PO BOX 3165
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71272-0001
Mailing Address - Country:US
Mailing Address - Phone:318-257-4764
Mailing Address - Fax:318-257-4492
Practice Address - Street 1:509 W ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4231
Practice Address - Country:US
Practice Address - Phone:318-257-2438
Practice Address - Fax:318-257-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5555231HA2400X
LA2197235Z00000X
LA5681231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty