Provider Demographics
NPI:1073047064
Name:SELECTIVE HEARING OF ACADIANA, LLC
Entity Type:Organization
Organization Name:SELECTIVE HEARING OF ACADIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:THOM
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:337-291-9939
Mailing Address - Street 1:110 EXCHANGE PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2580
Mailing Address - Country:US
Mailing Address - Phone:337-291-9939
Mailing Address - Fax:337-291-9023
Practice Address - Street 1:110 EXCHANGE PL
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2580
Practice Address - Country:US
Practice Address - Phone:337-291-9939
Practice Address - Fax:337-291-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6508231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760529739OtherNPI
LA1983756Medicaid
1255619748OtherNPI
LA2306944Medicaid