NPIMap

Organization Active NPI

Premier South Rehabilitation Services, LLC

  • Speech-Language Pathologist
  • Prairieville, LA
National Provider Identifier
1740302108
Registry record updated Apr 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
10-00820-078 Issued in LA
Legal business name
PREMIER SOUTH REHABILITATION SERVICES, LLC
Practice address
40302 Bordeaux St
Prairieville, LA 70769-5432
Phone
(225) 622-6541
Fax
(225) 622-6541
NPI assigned
Apr 5, 2007
Last updated
Apr 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2012

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

Authorized official

Name
Miss Dedra Michelle Stevenson, M. ED., CCC-SLPNPI 1033506381
Title
Agency Administrator
Phone
(225) 622-6541

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language PathologistGroup: 193400000X SINGLE SPECIALTY GROUP 235Z00000X 10-00820-078 LA Primary

Addresses

Primary practice location

40302 Bordeaux St
Prairieville, LA 70769-5432

Mailing address

37459 Ultima Plaza Blvd
Suite B-185
Prairieville, LA 70769-3856
Phone (225) 622-6541

National Provider Directory

National Provider Directory

Locations

37459 Ultima Plaza Blvd
Ste B185
Prairieville, LA 70769

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333670400000",
    "number": "1740302108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37459 ULTIMA PLAZA BLVD",
            "address_2": "SUITE B-185",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707693856",
            "telephone_number": "225-622-6541",
            "fax_number": "225-622-6541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40302 BORDEAUX ST",
            "city": "PRAIRIEVILLE",
            "state": "LA",
            "postal_code": "707695432",
            "telephone_number": "225-622-6541",
            "fax_number": "225-622-6541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SOUTH REHABILITATION SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-05",
        "last_updated": "2012-04-06",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "DEDRA",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "AGENCY ADMINISTRATOR",
        "authorized_official_telephone_number": "225-622-6541",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "M. ED., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "LA",
            "license": "10-00820-078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prairieville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2012; 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.