Individual
MRS. AMY L. BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
316 UPLAND DR, LAFAYETTE, LA 70506-6852
(337) 344-5407
(334) 344-5407
Mailing address
PO BOX 60601, LAFAYETTE, LA 70596-0601
(337) 344-5407
(337) 273-2583
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5135
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1472221
—
LA
Enumeration date
02/27/2007
Last updated
02/20/2013
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