Healthcare Provider Details

I. General information

NPI: 1316588817
Provider Name (Legal Business Name): ELIZABETH BUSHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 W MAIN ST STE 2
HOUMA LA
70360-4900
US

IV. Provider business mailing address

604 N ACADIA RD STE 101
THIBODAUX LA
70301-4897
US

V. Phone/Fax

Practice location:
  • Phone: 985-857-8838
  • Fax:
Mailing address:
  • Phone: 985-446-5079
  • Fax: 985-447-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number9663
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: