Provider Demographics
NPI:1376230177
Name:BOUDREAUX, MERCEDES SADE'
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:SADE'
Last Name:BOUDREAUX
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 1:125 RIDGEVIEW DR APT I7
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5062
Mailing Address - Country:US
Mailing Address - Phone:337-780-6719
Mailing Address - Fax:
Practice Address - Street 1:125 RIDGEVIEW DR APT I7
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5062
Practice Address - Country:US
Practice Address - Phone:337-780-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator