Provider Demographics
NPI:1073166047
Name:AMBEAU, CACIQUE CARDE' (MS, SLP-A)
Entity Type:Individual
Prefix:
First Name:CACIQUE
Middle Name:CARDE'
Last Name:AMBEAU
Suffix:
Gender:F
Credentials:MS, SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MORGAN AVE APT 3003
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1043
Mailing Address - Country:US
Mailing Address - Phone:504-206-0340
Mailing Address - Fax:
Practice Address - Street 1:6116 REIGER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4599
Practice Address - Country:US
Practice Address - Phone:972-502-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
TX423502355S0801X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant