| Lsu Health Shreveport - Allied Health Clinics Behavioral Health & Audi | |
|
1450 Claiborne Ave Shreveport LA 71103-4204 | |
| (318) 813-2972 | |
| (318) 813-2975 |
| Full Name | Lsu Health Shreveport - Allied Health Clinics Behavioral Health & Audi |
|---|---|
| Speciality | Clinic/Center |
| Location | 1450 Claiborne Ave, Shreveport, Louisiana |
| Authorized Official Name and Position | Sharon L. Dunn (DEAN, SAHP) |
| Authorized Official Contact | 3188132901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lsu Health Shreveport - Allied Health Clinics Behavioral Health & Audi 1450 Claiborne Ave Shreveport LA 71103-4204 Ph: (318) 813-2972 | Lsu Health Shreveport - Allied Health Clinics Behavioral Health & Audi 1450 Claiborne Ave Shreveport LA 71103-4204 Ph: (318) 813-2972 |
| NPI Number | 1740904291 |
|---|---|
| Provider Enumeration Date | 09/28/2022 |
| Last Update Date | 12/05/2023 |
| Certification Date | 05/30/2023 |
| Medicare PECOS PAC ID | 2860869526 |
|---|---|
| Medicare Enrollment ID | O20221109001624 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740904291 | NPI | - | NPPES |
| Provider Name | Michelle Yetman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306962279 PECOS PAC ID: 6507760923 Enrollment ID: I20031126000143 |
| Provider Name | Adam T Blancher |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497900187 PECOS PAC ID: 3274834940 Enrollment ID: I20151222002104 |
| Provider Name | Nanette M Massey |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1285657668 PECOS PAC ID: 2062713753 Enrollment ID: I20151222002815 |
| Provider Name | Robert F Hall |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1720179039 PECOS PAC ID: 3072870476 Enrollment ID: I20171120000809 |
| Provider Name | Rebecca Butler |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1295298388 PECOS PAC ID: 9931536091 Enrollment ID: I20200302001027 |
| Provider Name | Theresa Davidson Snow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841840311 PECOS PAC ID: 6103295712 Enrollment ID: I20221202002225 |
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