Provider Demographics
NPI:1700664331
Name:VEGA, NATALIE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 LESSARD ST
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2508
Mailing Address - Country:US
Mailing Address - Phone:225-571-6180
Mailing Address - Fax:
Practice Address - Street 1:31505 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:WHITE CASTLE
Practice Address - State:LA
Practice Address - Zip Code:70788-3628
Practice Address - Country:US
Practice Address - Phone:225-545-3805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist