Provider Demographics
NPI:1912620915
Name:CHARLEVILLE, JANICE FORSTALL (MCD)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:FORSTALL
Last Name:CHARLEVILLE
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3601
Mailing Address - Country:US
Mailing Address - Phone:504-228-5359
Mailing Address - Fax:
Practice Address - Street 1:801 N ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3601
Practice Address - Country:US
Practice Address - Phone:504-228-5359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1792235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist