Basic Information
| Provider Information | |||||||||
| NPI: | 1649449984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOUDREAUX | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | REINA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AU.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VALLES | ||||||||
| OtherFirstName: | MONICA | ||||||||
| OtherMiddleName: | REINA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.S. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 101 LOTTIE LN STE 2 | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365327309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519900535 | ||||||||
| FaxNumber: | 2519900538 | ||||||||
| Practice Location | |||||||||
| Address1: | 8154 HWY 59, SUITE 202 | ||||||||
| Address2: | |||||||||
| City: | FOLEY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519711152 | ||||||||
| FaxNumber: | 2519900538 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2008 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 7017 | LA | N | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | 1247A | AL | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237600000X | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 237700000X | 7017 | LA | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | 1247A | AL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.