Provider Demographics
NPI:1396263596
Name:FOURNET, JESSICA BEITZEL (SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BEITZEL
Last Name:FOURNET
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BEITZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4324 S. SHERWOOD FOREST BLVD
Mailing Address - Street 2:SUITE B 170
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4481
Mailing Address - Country:US
Mailing Address - Phone:225-654-8208
Mailing Address - Fax:225-465-8823
Practice Address - Street 1:425 SETTLERS TRACE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6048
Practice Address - Country:US
Practice Address - Phone:337-233-0322
Practice Address - Fax:337-233-0225
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
LA7525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7525OtherSPEECH
LA3320410Medicaid