Provider Demographics
NPI:1003308396
Name:BOUDREAUX, ELLEN (CPSS, ITE)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:CPSS, ITE
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:CHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPSS, ITE
Mailing Address - Street 1:945 RIDGEPOINT CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2877
Mailing Address - Country:US
Mailing Address - Phone:225-636-6161
Mailing Address - Fax:
Practice Address - Street 1:711 COLONIAL DR STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6549
Practice Address - Country:US
Practice Address - Phone:225-246-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist