Provider Demographics
NPI:1639272172
Name:ISTRE, CLIFTON O (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:O
Last Name:ISTRE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:350 LAKEVIEW CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7514
Mailing Address - Country:US
Mailing Address - Phone:985-845-3509
Mailing Address - Fax:985-867-5498
Practice Address - Street 1:350 LAKEVIEW CT
Practice Address - Street 2:SUITE A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7514
Practice Address - Country:US
Practice Address - Phone:985-845-3509
Practice Address - Fax:985-867-5498
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA156237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1680176Medicaid
LA1680176Medicaid