Organization
INFORMED DYSPHAGIA DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BLACKBURN (OWNER)
(203) 371-7311
Entity
Organization
Contact information
Practice address
1201 DEREK DR STE 1, HAMMOND, LA 70403-5755
(985) 805-2555
Mailing address
64300 BULLOCK CREEK RD, KENTWOOD, LA 70444-6284
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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