Individual
JEANETTE IRENE BUCKLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.C.D.
Contact information
Practice address
223 RUSSELL AVE, SHREVEPORT, LA 71105-3527
(318) 868-1547
Mailing address
223 RUSSELL AVE, SHREVEPORT, LA 71105-3527
(318) 868-1547
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5953
LA
Other
Enumeration date
11/23/2009
Last updated
11/23/2009
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