Provider Demographics
NPI:1265084057
Name:PRINCE, KATELAND JORDAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATELAND
Middle Name:JORDAN
Last Name:PRINCE
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 1:1009 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5539
Mailing Address - Country:US
Mailing Address - Phone:225-907-3915
Mailing Address - Fax:
Practice Address - Street 1:1600 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4410
Practice Address - Country:US
Practice Address - Phone:318-432-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8178235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist