Provider Demographics
NPI:1841321148
Name:CARAWAY, JUDY LANE
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LANE
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JUDY
Other - Middle Name:LANE
Other - Last Name:CARAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:18095 BRANDON DR E
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0271
Mailing Address - Country:US
Mailing Address - Phone:985-340-2925
Mailing Address - Fax:
Practice Address - Street 1:18095 BRANDON DR E
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0271
Practice Address - Country:US
Practice Address - Phone:985-340-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4500235Z00000X
MSS2361235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1624632Medicaid