Provider Demographics
NPI:1134497324
Name:BAYOU HEARING CLINIC, LLC
Entity Type:Organization
Organization Name:BAYOU HEARING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:THIBODAUX
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:985-325-4327
Mailing Address - Street 1:17052 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345
Mailing Address - Country:US
Mailing Address - Phone:985-325-4327
Mailing Address - Fax:985-325-4328
Practice Address - Street 1:17052 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345
Practice Address - Country:US
Practice Address - Phone:985-325-4327
Practice Address - Fax:985-325-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6428237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty