Individual
MS. KELLEY PRENDERGAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
3714 CYPRESS ST, WEST MONROE, LA 71291-7435
(318) 322-8974
(318) 322-8290
Mailing address
PO BOX 1462, MONROE, LA 71210-1462
(318) 387-7817
(318) 322-0914
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5894
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5894
SPEECH THERAPIST LICENSE
LA
Enumeration date
03/19/2008
Last updated
03/19/2008
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