Provider Demographics
NPI:1982814851
Name:ROBICHAUX, CHRISTY PELLEGRIN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:PELLEGRIN
Last Name:ROBICHAUX
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 GLENWILD DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8062
Mailing Address - Country:US
Mailing Address - Phone:985-855-1586
Mailing Address - Fax:985-493-7286
Practice Address - Street 1:429 GLENWILD DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-8062
Practice Address - Country:US
Practice Address - Phone:985-855-1586
Practice Address - Fax:985-493-7286
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4520235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1-31075-1Medicaid