Individual
ETHAN HYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
1727 IMPERIAL BLVD BLDG 3, LAKE CHARLES, LA 70605-5393
(337) 478-5880
(337) 478-5879
Mailing address
1727 IMPERIAL BLVD BLDG 3, LAKE CHARLES, LA 70605-5393
(337) 478-5880
(337) 478-5879
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
8106
LA
Other
Enumeration date
04/03/2019
Last updated
04/03/2019
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