Provider Demographics
NPI:1164234415
Name:CELESTINE, AVRIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:AVRIE
Middle Name:
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4053 BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-3607
Mailing Address - Country:US
Mailing Address - Phone:337-496-7130
Mailing Address - Fax:
Practice Address - Street 1:3310 BROAD ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-3808
Practice Address - Country:US
Practice Address - Phone:337-217-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist