Provider Demographics
NPI:1437373354
Name:CUPSTID, LAQUITA RENEE (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LAQUITA
Middle Name:RENEE
Last Name:CUPSTID
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4452
Mailing Address - Country:US
Mailing Address - Phone:601-596-5777
Mailing Address - Fax:
Practice Address - Street 1:3617 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4452
Practice Address - Country:US
Practice Address - Phone:601-596-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105572235Z00000X
NM426498235Z00000X
LA8485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist