Provider Demographics
NPI:1972221992
Name:PAILLE, MANDI (BS, SLP-ASSISTANT)
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:
Last Name:PAILLE
Suffix:
Gender:F
Credentials:BS, SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-1130
Mailing Address - Country:US
Mailing Address - Phone:225-686-4280
Mailing Address - Fax:225-686-4335
Practice Address - Street 1:26535 LA HIGHWAY 16 STE B
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5849
Practice Address - Country:US
Practice Address - Phone:225-664-4221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA75372355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2355S0801XMedicaid
LA7537Medicaid