Amy L. Bacon, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5135 Issued in LA

Practice address

316 Upland Dr
Lafayette, LA 70506-6852

Phone

(337) 344-5407

Fax

(334) 344-5407

NPI assigned

Feb 27, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Let'S Talk, L.L.C.

  • Early Intervention Provider Agency
  • Lafayette, LA
  • NPI 1609130822
  NPD (past) Authorized official

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361318400000",
    "number": "1245367176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60601",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705960601",
            "telephone_number": "337-344-5407",
            "fax_number": "337-273-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 UPLAND DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705066852",
            "telephone_number": "337-344-5407",
            "fax_number": "334-344-5407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "AMY",
        "middle_name": "L.",
        "name_prefix": "Mrs.",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-27",
        "last_updated": "2013-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "5135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1472221",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrino Babino
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• Back to the Real World LLC
• Frank R Bacque, M.D.
• Kayla Badon, BCBA, LBA
• Amir Bagshahi
• Melissa Bagwell, MA
• Bahman Daneshfar MD, Apmc

• All providers in Lafayette, LA
• Speech-Language Pathologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; 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.