Provider Demographics
NPI:1861143471
Name:LANDRY, LISA BARBARA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BARBARA
Last Name:LANDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2389A HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-9295
Mailing Address - Country:US
Mailing Address - Phone:985-713-2352
Mailing Address - Fax:
Practice Address - Street 1:2389A HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-9295
Practice Address - Country:US
Practice Address - Phone:985-713-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist