Provider Demographics
NPI:1275398620
Name:CHARBONNET, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:CHARBONNET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4030
Mailing Address - Country:US
Mailing Address - Phone:504-905-6296
Mailing Address - Fax:
Practice Address - Street 1:223 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4030
Practice Address - Country:US
Practice Address - Phone:504-905-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4287237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter