Provider Demographics
NPI:1033391404
Name:BOUDLOCHE, CHRISTY M (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:M
Last Name:BOUDLOCHE
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 DOUCET RD
Mailing Address - Street 2:A-2
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3444
Mailing Address - Country:US
Mailing Address - Phone:337-298-9714
Mailing Address - Fax:337-216-7787
Practice Address - Street 1:353 DOUCET RD
Practice Address - Street 2:A-2
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3444
Practice Address - Country:US
Practice Address - Phone:337-298-9714
Practice Address - Fax:337-216-7787
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist