Provider Demographics
NPI:1740443894
Name:ACADIANA SPEECH THERAPY SEVICES
Entity type:Organization
Organization Name:ACADIANA SPEECH THERAPY SEVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:RHYNE
Authorized Official - Last Name:MAHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:337-788-2300
Mailing Address - Street 1:PO BOX 2206
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70527-2206
Mailing Address - Country:US
Mailing Address - Phone:337-788-2300
Mailing Address - Fax:888-214-8710
Practice Address - Street 1:225 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-4332
Practice Address - Country:US
Practice Address - Phone:337-788-2300
Practice Address - Fax:888-214-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty