Provider Demographics
NPI:1972560035
Name:ELDER, MARIE T (MCD, CCC-AUD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:T
Last Name:ELDER
Suffix:
Gender:F
Credentials:MCD, CCC-AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 N. CAUSEWAY BLVD.
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-705-0112
Mailing Address - Fax:866-255-5506
Practice Address - Street 1:1750 N. CAUSEWAY BLVD.
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-705-0112
Practice Address - Fax:866-255-5506
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAU3144231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C145Medicare ID - Type Unspecified