Provider Demographics
NPI:1841321924
Name:PEDIATRIC SPEECH AND LANGUAGE SERVICES
Entity type:Organization
Organization Name:PEDIATRIC SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEGOULLON
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:337-893-1501
Mailing Address - Street 1:9029 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-2173
Mailing Address - Country:US
Mailing Address - Phone:337-893-1501
Mailing Address - Fax:337-893-6607
Practice Address - Street 1:9029 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-2173
Practice Address - Country:US
Practice Address - Phone:337-893-1501
Practice Address - Fax:337-893-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty