Provider Demographics
NPI:1750794665
Name:FAUL, KACEY AMEDEE
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:AMEDEE
Last Name:FAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-7115
Mailing Address - Country:US
Mailing Address - Phone:985-852-1761
Mailing Address - Fax:985-798-7543
Practice Address - Street 1:13343 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAROSE
Practice Address - State:LA
Practice Address - Zip Code:70373-2408
Practice Address - Country:US
Practice Address - Phone:985-798-7557
Practice Address - Fax:985-798-7543
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist