Provider Demographics
NPI:1326076720
Name:OSBORNE, MARY ELAINE M
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELAINE M
Last Name:OSBORNE
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 1:1100 N VICTOR II BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1331
Mailing Address - Country:US
Mailing Address - Phone:985-385-4327
Mailing Address - Fax:985-385-1988
Practice Address - Street 1:1100 N VICTOR II BLVD
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1331
Practice Address - Country:US
Practice Address - Phone:985-385-4327
Practice Address - Fax:985-385-1988
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4239231H00000X, 235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1544612Medicaid
LA4239OtherSTATE LICENSE NUMBER
LA4239OtherSTATE LICENSE NUMBER