Informed Dysphagia Diagnostics LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

INFORMED DYSPHAGIA DIAGNOSTICS LLC

Practice address

1201 Derek Dr Ste 1
Hammond, LA 70403-5755

Phone

(985) 805-2555

NPI assigned

Oct 13, 2020

Organization subpart

No

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

Authorized official

Name

William BlackburnNPI 1447805064

Title

Owner

Phone

(203) 371-7311

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• William Blackburn, MS

  • Speech-Language Pathologist
  • Covington, LA
  • NPI 1447805064
  NPD Authorized official

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1336747237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64300 BULLOCK CREEK RD",
            "city": "KENTWOOD",
            "state": "LA",
            "postal_code": "704446284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 DEREK DR STE 1",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704035755",
            "telephone_number": "985-805-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFORMED DYSPHAGIA DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-13",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-371-7311"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Hammond, LA
• Providers in Hammond, 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 Oct 13, 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.