Provider Demographics
NPI:1720110810
Name:LEMOINE, PAMELA DAIGREPONT (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DAIGREPONT
Last Name:LEMOINE
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25680 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6044
Mailing Address - Country:US
Mailing Address - Phone:225-978-1641
Mailing Address - Fax:225-791-6578
Practice Address - Street 1:25680 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-6044
Practice Address - Country:US
Practice Address - Phone:225-978-1641
Practice Address - Fax:225-791-6578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301167Medicaid