Provider Demographics
NPI:1295068344
Name:EXCEPTIONAL THERAPY SERVICES OF LOUISIANA, LLC
Entity type:Organization
Organization Name:EXCEPTIONAL THERAPY SERVICES OF LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:NEDRA
Authorized Official - Middle Name:GENELLE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:281-640-0061
Mailing Address - Street 1:3141 TOUCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-1626
Mailing Address - Country:US
Mailing Address - Phone:281-640-0061
Mailing Address - Fax:
Practice Address - Street 1:3141 TOUCHWOOD DR
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-1626
Practice Address - Country:US
Practice Address - Phone:281-640-0061
Practice Address - Fax:888-512-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102041235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty