Provider Demographics
NPI:1942886288
Name:BEAUBOEUF, MACEY LEE (CCC- SLP)
Entity Type:Individual
Prefix:MRS
First Name:MACEY
Middle Name:LEE
Last Name:BEAUBOEUF
Suffix:
Gender:F
Credentials:CCC- SLP
Other - Prefix:
Other - First Name:MACEY
Other - Middle Name:LEE
Other - Last Name:MATHESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2424 COULEE CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485-9730
Mailing Address - Country:US
Mailing Address - Phone:318-229-3742
Mailing Address - Fax:
Practice Address - Street 1:13727 NOEL RD STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-1338
Practice Address - Country:US
Practice Address - Phone:972-851-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist