Provider Demographics
NPI:1982975785
Name:DOMENGEAUX, JENNIFER MAGEE (SLP)
Entity Type:Individual
Prefix:PROF
First Name:JENNIFER
Middle Name:MAGEE
Last Name:DOMENGEAUX
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:PROF
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:850 N PIERCE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2848
Mailing Address - Country:US
Mailing Address - Phone:337-261-9100
Mailing Address - Fax:337-261-9700
Practice Address - Street 1:850 N PIERCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2848
Practice Address - Country:US
Practice Address - Phone:337-261-9100
Practice Address - Fax:337-261-9700
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist