Provider Demographics
NPI:1285065722
Name:LAFOLLETTE, TREASURE
Entity type:Individual
Prefix:
First Name:TREASURE
Middle Name:
Last Name:LAFOLLETTE
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 1:3600 S TEXAS AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3769
Mailing Address - Country:US
Mailing Address - Phone:979-779-3070
Mailing Address - Fax:979-779-7565
Practice Address - Street 1:3600 S TEXAS AVE STE 400
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3769
Practice Address - Country:US
Practice Address - Phone:979-779-3070
Practice Address - Fax:979-779-7565
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80399237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist