Provider Demographics
NPI:1356631584
Name:STUART, JUSTIN (HIS)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 JOHNSTON ST STE 502
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5334
Mailing Address - Country:US
Mailing Address - Phone:318-219-4155
Mailing Address - Fax:318-861-1880
Practice Address - Street 1:5737 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4216
Practice Address - Country:US
Practice Address - Phone:318-219-4155
Practice Address - Fax:318-861-1880
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1173237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist