Provider Demographics
NPI:1568593036
Name:DUFRENE, STEPHANIE G (MS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:G
Last Name:DUFRENE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 BALD CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-1088
Mailing Address - Country:US
Mailing Address - Phone:985-951-8340
Mailing Address - Fax:985-951-8340
Practice Address - Street 1:981 BALD CYPRESS DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-1088
Practice Address - Country:US
Practice Address - Phone:504-220-4166
Practice Address - Fax:985-951-8340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1621315Medicaid