Healthcare Provider Details

I. General information

NPI: 1114843364
Provider Name (Legal Business Name): HANNAH BOUDREAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SAINT JOHN ST
LAFAYETTE LA
70501-6706
US

IV. Provider business mailing address

720 SAINT JOHN ST
LAFAYETTE LA
70501-6706
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-2090
  • Fax:
Mailing address:
  • Phone: 337-237-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19829
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: