Individual
SHELIA FONSECA SOUTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, CCC,SLP
Contact information
Practice address
25 ZEE ANN DR, LULING, LA 70070-3130
(985) 785-2952
Mailing address
25 ZEE ANN DR, LULING, LA 70070-3130
(985) 785-2952
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2859
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1310875
—
LA
Enumeration date
03/10/2007
Last updated
07/08/2007
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