Individual
LYNETTE A WESLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1705 SULLIVAN DR, BOGALUSA, LA 70427-5884
(985) 281-2200
Mailing address
423 N MAIN ST, POPLARVILLE, MS 39470-2317
(601) 916-0530
(769) 926-2442
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8488
LA
235Z00000X
Speech-Language Pathologist
S0483
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700112315
—
MS
Enumeration date
11/02/2009
Last updated
10/13/2021
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