1437877511 NPI number — STEFANIE THIBODAUX PROTHRO CCC-SLP

Table of content: STEFANIE THIBODAUX PROTHRO CCC-SLP (NPI 1437877511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437877511 NPI number — STEFANIE THIBODAUX PROTHRO CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROTHRO
Provider First Name:
STEFANIE
Provider Middle Name:
THIBODAUX
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437877511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 DAYNA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARENCRO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70520-5148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-520-5029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 TEEMA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARENCRO
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70520-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-521-7640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  4192 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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