Provider Demographics
NPI:1912719055
Name:DELTA DYSPHAGIA DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:DELTA DYSPHAGIA DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANNA
Authorized Official - Middle Name:BRANCH
Authorized Official - Last Name:DARK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:318-235-8644
Mailing Address - Street 1:82 BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-6521
Mailing Address - Country:US
Mailing Address - Phone:318-235-8644
Mailing Address - Fax:
Practice Address - Street 1:82 BAYOU RD
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-6521
Practice Address - Country:US
Practice Address - Phone:318-235-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty