Active NPI
Melanie Baker Russo
- Speech-Language Pathologist
- Broussard, LA
National Provider Identifier
1538838545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 6925
- Practice address
- 1325 S Morgan Ave
Broussard, LA 70518-5121 - Phone
- (337) 521-7870
- NPI assigned
- Sep 13, 2021
- Last updated
- Sep 13, 2021
- Sex
- Female
- Sole proprietor
- No
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 | 6925 | LA | Primary |
Addresses
Primary practice location
1325 S Morgan Ave
Broussard, LA 70518-5121
Mailing address
105 Journey LN
Lafayette, LA 70506-6655
Phone (337) 212-5921
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 |
|---|---|---|---|
| 6925 | LA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631491200000",
"number": "1538838545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 JOURNEY LN",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705066655",
"telephone_number": "337-212-5921"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 S MORGAN AVE",
"city": "BROUSSARD",
"state": "LA",
"postal_code": "705185121",
"telephone_number": "337-521-7870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAKER RUSSO",
"first_name": "MELANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-13",
"last_updated": "2021-09-13",
"certification_date": "2021-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "LA",
"license": "6925",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broussard, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.