Individual
MRS. STACIE MARIE PROVOSTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
3419 SAINT CLAUDE AVE, NEW ORLEANS, LA 70117-6144
(504) 330-8160
Mailing address
2833 JOSEPH ST, NEW ORLEANS, LA 70115-7043
(504) 864-8311
(504) 864-8311
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5819
LA
235Z00000X
Speech-Language Pathologist
8000
OH
Other
Enumeration date
09/14/2007
Last updated
09/14/2007
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