Provider Demographics
NPI:1184151185
Name:FONTENOT, SKYLER
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:
Last Name:FONTENOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2368
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-2368
Mailing Address - Country:US
Mailing Address - Phone:337-478-5880
Mailing Address - Fax:337-478-5879
Practice Address - Street 1:1717 E PRIEN LAKE RD STE 1
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-0400
Practice Address - Country:US
Practice Address - Phone:337-478-5880
Practice Address - Fax:337-478-5879
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist