Provider Demographics
NPI:1164913463
Name:WHITE, BRIANNE T
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:T
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 CAMELLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6679
Mailing Address - Country:US
Mailing Address - Phone:337-993-1335
Mailing Address - Fax:337-993-1339
Practice Address - Street 1:1039 CAMELLIA BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6679
Practice Address - Country:US
Practice Address - Phone:337-993-1335
Practice Address - Fax:337-993-1339
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist