Provider Demographics
NPI:1174944417
Name:STURTEVANT, PHILLIP (LHAS)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:STURTEVANT
Suffix:
Gender:M
Credentials:LHAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 JOHNSTON ST STE 502
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5334
Mailing Address - Country:US
Mailing Address - Phone:231-739-5100
Mailing Address - Fax:231-739-5161
Practice Address - Street 1:1820 BELLE CHASSE HWY STE 106
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7021
Practice Address - Country:US
Practice Address - Phone:231-739-5100
Practice Address - Fax:231-739-5161
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501005499237700000X
MSHA0675237700000X
LA1310237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist