The Speech Pathology Center of Louisiana, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2002 Issued in LA

Legal business name

THE SPEECH PATHOLOGY CENTER OF LOUISIANA, LLC

Practice address

8676 Goodwood Blvd
Suite 204
Baton Rouge, LA 70806-7914

Phone

(225) 923-1140

Fax

(225) 923-1326

NPI assigned

Nov 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mondra Rose Fazely, CCCNPI 1316016181

Title

Member

Phone

(225) 923-1140

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mondra Rose Fazely, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Baton Rouge, LA
  • NPI 1316016181
  NPD (past) Authorized official
• Tami Grigsby Moran, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Baton Rouge, LA
  • NPI 1861571895
  NPD (past)
• Shannon S Morgan, M.C.D.,CCC-SLP

  • Speech-Language Pathologist
  • Baton Rouge, LA
  • NPI 1134257561
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164591038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8676 GOODWOOD BLVD",
            "address_2": "SUITE 204",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067914",
            "telephone_number": "225-923-1140",
            "fax_number": "225-923-1326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8676 GOODWOOD BLVD",
            "address_2": "SUITE 204",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067914",
            "telephone_number": "225-923-1140",
            "fax_number": "225-923-1326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SPEECH PATHOLOGY CENTER OF LOUISIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FAZELY",
        "authorized_official_first_name": "MONDRA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "225-923-1140",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CCC"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "2002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.