Provider Demographics
NPI:1457551723
Name:LOUISIANA TECH UNIVERSITY
Entity Type:Organization
Organization Name:LOUISIANA TECH UNIVERSITY
Other - Org Name:LOUISIANA TECH SPEECH AND HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:318-257-4764
Mailing Address - Street 1:305 WISTERIA STREET
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71272-0001
Mailing Address - Country:US
Mailing Address - Phone:318-257-2000
Mailing Address - Fax:
Practice Address - Street 1:120 ROBINSON HALL
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71272-0001
Practice Address - Country:US
Practice Address - Phone:318-257-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5681231H00000X
LA5708231H00000X
LA5555231H00000X
LA3491231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty