Provider Demographics
NPI:1093078354
Name:CAVANAUGH, JAKE (AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6010
Mailing Address - Country:US
Mailing Address - Phone:337-528-7842
Mailing Address - Fax:337-888-3157
Practice Address - Street 1:2100 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6010
Practice Address - Country:US
Practice Address - Phone:337-528-7842
Practice Address - Fax:337-888-3157
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6706231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist