Provider Demographics
NPI:1881926178
Name:FAVOR, ALINE S (SLP)
Entity type:Individual
Prefix:
First Name:ALINE
Middle Name:S
Last Name:FAVOR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47322 HIGHWAY 445
Mailing Address - Street 2:
Mailing Address - City:ROBERT
Mailing Address - State:LA
Mailing Address - Zip Code:70455-1802
Mailing Address - Country:US
Mailing Address - Phone:985-340-0977
Mailing Address - Fax:
Practice Address - Street 1:47322 HIGHWAY 445
Practice Address - Street 2:
Practice Address - City:ROBERT
Practice Address - State:LA
Practice Address - Zip Code:70455-1802
Practice Address - Country:US
Practice Address - Phone:985-340-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist