1447633698 NPI number — HARGROVE SPEECH LANGUAGE PATHOLOGY, LLC

Table of content: (NPI 1447633698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447633698 NPI number — HARGROVE SPEECH LANGUAGE PATHOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARGROVE SPEECH LANGUAGE PATHOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1447633698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8870 YOUREE DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71115-2512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8870 YOUREE DR
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71115-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-393-8729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HARGROVE
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
MCCOY
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
318-393-8729

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  6575 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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