Provider Demographics
NPI:1366775900
Name:PELICAN, EMILY D (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:D
Last Name:PELICAN
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 LIN MAL RD
Mailing Address - Street 2:
Mailing Address - City:KINDER
Mailing Address - State:LA
Mailing Address - Zip Code:70648-5139
Mailing Address - Country:US
Mailing Address - Phone:337-789-3415
Mailing Address - Fax:
Practice Address - Street 1:349 LIN MAL RD
Practice Address - Street 2:
Practice Address - City:KINDER
Practice Address - State:LA
Practice Address - Zip Code:70648-5139
Practice Address - Country:US
Practice Address - Phone:337-789-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B326Medicare PIN