Provider Demographics
NPI:1699208868
Name:LEBOURGEOIS, KALLIE R (AUD)
Entity Type:Individual
Prefix:DR
First Name:KALLIE
Middle Name:R
Last Name:LEBOURGEOIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:985-447-2497
Practice Address - Street 1:8080 BLUEBONNET BLVD
Practice Address - Street 2:SUITE 2121
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-408-6734
Practice Address - Fax:225-766-3851
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7586237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter