Provider Demographics
NPI:1881724938
Name:MAURO, CELESTE CREWS (MS L-SLP CCC-SLP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:CREWS
Last Name:MAURO
Suffix:
Gender:F
Credentials:MS L-SLP CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-1130
Mailing Address - Country:US
Mailing Address - Phone:225-686-4319
Mailing Address - Fax:
Practice Address - Street 1:13909 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754-6340
Practice Address - Country:US
Practice Address - Phone:225-686-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3767235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.017545OtherIL LIC
LA1-47427-4Medicaid
LA2643118Medicaid
LA3767OtherLA LICENCE NUMBER
KY289132OtherKY LIC