Provider Demographics
NPI:1356995849
Name:HAYNES, JULIANNE BRIELLE (MCD)
Entity type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:BRIELLE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 E ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4529
Mailing Address - Country:US
Mailing Address - Phone:318-469-6872
Mailing Address - Fax:
Practice Address - Street 1:1950 E 70TH ST STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5345
Practice Address - Country:US
Practice Address - Phone:318-219-6064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist