Provider Demographics
NPI:1194749499
Name:IRWIN, DAVID L (SLP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:IRWIN
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CLAIBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4204
Mailing Address - Country:US
Mailing Address - Phone:318-813-2970
Mailing Address - Fax:318-813-2975
Practice Address - Street 1:3735 BLAIR DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4601
Practice Address - Country:US
Practice Address - Phone:318-813-4200
Practice Address - Fax:318-813-4217
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174173Medicaid
LA1174173Medicaid