Provider Demographics
NPI:1639367097
Name:DAUZAT, KIM (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:DAUZAT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3243
Mailing Address - Country:US
Mailing Address - Phone:985-626-8403
Mailing Address - Fax:985-727-9871
Practice Address - Street 1:1011 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 25
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3243
Practice Address - Country:US
Practice Address - Phone:985-626-8403
Practice Address - Fax:985-727-9871
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist