Organization
PREMIER SOUTH REHABILITATION SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DEDRA MICHELLE STEVENSON M. ED., CCC-SLP (AGENCY ADMINISTRATOR)
(225) 622-6541
Entity
Organization
Contact information
Practice address
40302 BORDEAUX ST, PRAIRIEVILLE, LA 70769-5432
(225) 622-6541
(225) 622-6541
Mailing address
37459 ULTIMA PLAZA BLVD, SUITE B-185, PRAIRIEVILLE, LA 70769-3856
(225) 622-6541
(225) 622-6541
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10-00820-078
LA
Other
Enumeration date
04/05/2007
Last updated
04/06/2012
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