Provider Demographics
NPI:1336420629
Name:MENARD, REBECCA JOHNSON (AUD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JOHNSON
Last Name:MENARD
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 1:804 PELICAN RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5863
Mailing Address - Country:US
Mailing Address - Phone:337-278-1079
Mailing Address - Fax:
Practice Address - Street 1:315 S COLLEGE RD
Practice Address - Street 2:STE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3212
Practice Address - Country:US
Practice Address - Phone:337-235-6601
Practice Address - Fax:337-232-0772
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6550231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist