Individual
MITZI R. BRUNET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,CCC,SLP
Contact information
Practice address
106 WEST 164 STREET, GALLIANO, LA 70354
(985) 632-4763
Mailing address
PO BOX 466, CUT OFF, LA 70345-0466
(985) 632-4763
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3439
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1472352
—
LA
Enumeration date
03/13/2007
Last updated
07/08/2007
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