Provider Demographics
NPI:1265620397
Name:JOHNSON & JOHNSON'S SPEECH, LANGUAGE, AND HEARING CLINIC, LLC
Entity type:Organization
Organization Name:JOHNSON & JOHNSON'S SPEECH, LANGUAGE, AND HEARING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SPEECHLANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JUANTA
Authorized Official - Middle Name:TRENISE
Authorized Official - Last Name:BUGGAGE
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:225-244-1823
Mailing Address - Street 1:14453 BYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70819-2006
Mailing Address - Country:US
Mailing Address - Phone:225-244-1823
Mailing Address - Fax:225-376-4801
Practice Address - Street 1:2036 WOODDALE BLVD
Practice Address - Street 2:SUITE L
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1518
Practice Address - Country:US
Practice Address - Phone:225-928-6887
Practice Address - Fax:225-928-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5824252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1023680Medicaid