Provider Demographics
NPI:1679073365
Name:BOUDREAUX, DANIELLE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13612 SHADY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-2843
Mailing Address - Country:US
Mailing Address - Phone:225-892-5943
Mailing Address - Fax:
Practice Address - Street 1:9063 SIEGEN LN STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2051
Practice Address - Country:US
Practice Address - Phone:225-294-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA468103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst