Active NPI
Candace Saraceno Revere, CCC-SLP
- Speech-Language Pathologist
- Hammond, LA
National Provider Identifier
1215119094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 5664
- Practice address
- 11404 Jerusalem Baptist Church Rd
Hammond, LA 70403-1940 - Phone
- (985) 402-0507
- NPI assigned
- Dec 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 5664 | LA | Primary |
Addresses
Primary practice location
11404 Jerusalem Baptist Church Rd
Hammond, LA 70403-1940
Mailing address
11404 Jerusalem Baptist Church Rd
Hammond, LA 70403-1940
Phone (985) 402-0507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5664 | LA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597708800000",
"number": "1215119094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11404 JERUSALEM BAPTIST CHURCH RD",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704031940",
"telephone_number": "985-402-0507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11404 JERUSALEM BAPTIST CHURCH RD",
"city": "HAMMOND",
"state": "LA",
"postal_code": "704031940",
"telephone_number": "985-402-0507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVERE",
"first_name": "CANDACE",
"middle_name": "SARACENO",
"name_prefix": "Ms.",
"credential": "CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-03",
"last_updated": "2020-08-18",
"certification_date": "2020-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "LA",
"license": "5664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hammond, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.