Provider Demographics
NPI:1376864140
Name:THIBODEAUX, LOREN CHRISTIAN (AUD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:CHRISTIAN
Last Name:THIBODEAUX
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 KERNIS HUVAL LANE
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584
Mailing Address - Country:US
Mailing Address - Phone:337-230-6342
Mailing Address - Fax:337-989-2289
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:BUILDING A SUITE 402
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-988-6798
Practice Address - Fax:337-989-2289
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6333237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter