Provider Demographics
NPI:1083330211
Name:NELSON, DAVETTA (L-SLP CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DAVETTA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:L-SLP CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10708 BIG BEND AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-5202
Mailing Address - Country:US
Mailing Address - Phone:225-278-2935
Mailing Address - Fax:
Practice Address - Street 1:10708 BIG BEND AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-5202
Practice Address - Country:US
Practice Address - Phone:225-278-2935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist