Provider Demographics
NPI:1073775201
Name:GUIDRY, RENEE JEANNE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:JEANNE
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 MYRTLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1232
Mailing Address - Country:US
Mailing Address - Phone:225-921-0361
Mailing Address - Fax:866-694-2857
Practice Address - Street 1:3403 MYRTLE GROVE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1234
Practice Address - Country:US
Practice Address - Phone:225-921-0361
Practice Address - Fax:866-694-2857
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2008-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-06-3066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist