Provider Demographics
NPI:1134275399
Name:HULSEWE, MERRITT PAGE (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MERRITT
Middle Name:PAGE
Last Name:HULSEWE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 HERMITAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8371
Mailing Address - Country:US
Mailing Address - Phone:713-412-5445
Mailing Address - Fax:
Practice Address - Street 1:296 HERMITAGE LOOP
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-8371
Practice Address - Country:US
Practice Address - Phone:713-412-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1038687Medicaid