Healthcare Provider Details

I. General information

NPI: 1134904634
Provider Name (Legal Business Name): EMMA MARIE THIBODEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 PICARDY AVE
BATON ROUGE LA
70809-3686
US

IV. Provider business mailing address

10720 LINKWOOD CT APT 1225
BATON ROUGE LA
70810-2952
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-5032
  • Fax:
Mailing address:
  • Phone: 601-870-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9446
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9446
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: