Individual
MS. MONDRA ROSE FAZELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
8676 GOODWOOD BLVD, SUITE 204, BATON ROUGE, LA 70806-7914
(225) 923-1140
(225) 923-1326
Mailing address
637 CARRIAGE WAY, BATON ROUGE, LA 70808-4832
(225) 769-7479
(225) 923-1326
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2002
LA
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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