Individual
MRS. ALICIA FONDA MALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1128 HIDDEN OAK LN, LAKE CHARLES, LA 70605-7123
(337) 794-2744
Mailing address
1128 HIDDEN OAK LN, LAKE CHARLES, LA 70605-7123
(337) 794-2744
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7029
LA
Other
Enumeration date
06/09/2019
Last updated
06/09/2019
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