Provider Demographics
NPI:1376808774
Name:SELF, CATHERINE DREZ (CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:DREZ
Last Name:SELF
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 BROAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4224
Mailing Address - Country:US
Mailing Address - Phone:337-491-0800
Mailing Address - Fax:337-491-0508
Practice Address - Street 1:314 BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4224
Practice Address - Country:US
Practice Address - Phone:337-491-0800
Practice Address - Fax:337-491-0508
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3252231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist