Provider Demographics
NPI:1295064772
Name:SCIPPER, AUDREA M (MS, SLP)
Entity type:Individual
Prefix:
First Name:AUDREA
Middle Name:M
Last Name:SCIPPER
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21337 HIGHWAY 26
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-8534
Mailing Address - Country:US
Mailing Address - Phone:601-955-1215
Mailing Address - Fax:
Practice Address - Street 1:21337 HIGHWAY 26
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-8534
Practice Address - Country:US
Practice Address - Phone:601-955-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6037235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist