Provider Demographics
NPI:1689907750
Name:BOUDREAUX, LORNA HARRALL (MS L-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:HARRALL
Last Name:BOUDREAUX
Suffix:
Gender:F
Credentials:MS L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-3014
Mailing Address - Country:US
Mailing Address - Phone:985-381-6636
Mailing Address - Fax:
Practice Address - Street 1:412 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-3014
Practice Address - Country:US
Practice Address - Phone:985-381-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist