Provider Demographics
NPI:1952567273
Name:POOLSON, AMY DAVIS (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DAVIS
Last Name:POOLSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 AMBASSADOR CAFFERY PARKWAY
Mailing Address - Street 2:BLDG., SUITE 402
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6949
Mailing Address - Country:US
Mailing Address - Phone:337-989-4453
Mailing Address - Fax:337-989-2289
Practice Address - Street 1:4630 AMBASSADOR CAFFERY PARKWAY
Practice Address - Street 2:BLDG., A, SUITE 402
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6949
Practice Address - Country:US
Practice Address - Phone:337-989-4453
Practice Address - Fax:337-989-2289
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5479231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1372293Medicaid
LA1372293Medicaid