Individual
MRS. EMILY BASS WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
901 N 4TH ST, MONROE, LA 71201-5909
(318) 387-7817
(318) 322-0914
Mailing address
2606 BELOIT ST, MONROE, LA 71201-2515
(318) 680-1618
(318) 329-3666
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6558146
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1408026
—
LA
Enumeration date
03/02/2007
Last updated
01/11/2022
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