Provider Demographics
NPI:1861776957
Name:NEELY, LAURA ELLEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELLEN
Last Name:NEELY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10619 HIGHWAY 171
Mailing Address - Street 2:
Mailing Address - City:LONGVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70652-4112
Mailing Address - Country:US
Mailing Address - Phone:337-515-7339
Mailing Address - Fax:
Practice Address - Street 1:10619 HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:LONGVILLE
Practice Address - State:LA
Practice Address - Zip Code:70652-4112
Practice Address - Country:US
Practice Address - Phone:337-515-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist