Healthcare Provider Details

I. General information

NPI: 1952567273
Provider Name (Legal Business Name): AMY DAVIS POOLSON AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PARKWAY BLDG., A, SUITE 402
LAFAYETTE LA
70508-6949
US

IV. Provider business mailing address

4630 AMBASSADOR CAFFERY PARKWAY BLDG., SUITE 402
LAFAYETTE LA
70508-6949
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-4453
  • Fax: 337-989-2289
Mailing address:
  • Phone: 337-989-4453
  • Fax: 337-989-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number5479
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: