Provider Demographics
NPI:1740029958
Name:AUBIN, MYRA L (MS, SLP)
Entity type:Individual
Prefix:MS
First Name:MYRA
Middle Name:L
Last Name:AUBIN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4036 OLIVIA DR
Mailing Address - Street 2:
Mailing Address - City:ADDIS
Mailing Address - State:LA
Mailing Address - Zip Code:70710-3042
Mailing Address - Country:US
Mailing Address - Phone:225-343-8405
Mailing Address - Fax:225-343-8470
Practice Address - Street 1:609 ROSEDALE RD
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2157
Practice Address - Country:US
Practice Address - Phone:225-343-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist