Individual
TRACIE CHAMPAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(225) 654-8208
(225) 654-4642
Mailing address
1326 CHURCH ST, ZACHARY, LA 70791-2743
(225) 654-8208
(225) 654-4642
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7493
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7493
STATE LICENSE
LA
Enumeration date
05/21/2018
Last updated
05/21/2018
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