Provider Demographics
NPI:1295063964
Name:REDDING, ELIZABETH (SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:REDDING
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 STUBBS AVE
Mailing Address - Street 2:STE D
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-388-8414
Mailing Address - Fax:318-388-8558
Practice Address - Street 1:803 STUBBS AVE
Practice Address - Street 2:STE D
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-388-8414
Practice Address - Fax:318-388-8558
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAOTA200143OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS