Provider Demographics
NPI:1609345123
Name:MAURIN, EMILY MAE (MA, L-SLP, CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:MAURIN
Suffix:
Gender:F
Credentials:MA, L-SLP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047-3624
Mailing Address - Country:US
Mailing Address - Phone:504-609-9245
Mailing Address - Fax:
Practice Address - Street 1:13855 RIVER RD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-6220
Practice Address - Country:US
Practice Address - Phone:985-785-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
LA9155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician