Provider Demographics
NPI:1871736264
Name:BUGGAGE, JUANTA T (MED)
Entity type:Individual
Prefix:MS
First Name:JUANTA
Middle Name:T
Last Name:BUGGAGE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 DENNIS MACK LN
Mailing Address - Street 2:
Mailing Address - City:ETHEL
Mailing Address - State:LA
Mailing Address - Zip Code:70730-4031
Mailing Address - Country:US
Mailing Address - Phone:225-244-1823
Mailing Address - Fax:225-683-4882
Practice Address - Street 1:5941 DENNIS MACK LN
Practice Address - Street 2:
Practice Address - City:ETHEL
Practice Address - State:LA
Practice Address - Zip Code:70730-4031
Practice Address - Country:US
Practice Address - Phone:225-244-1823
Practice Address - Fax:225-683-4882
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist