Healthcare Provider Details

I. General information

NPI: 1346941176
Provider Name (Legal Business Name): JENNIFER BERNADETTE BROYARD MCD, CCC A/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 WESTBEND PKWY
NEW ORLEANS LA
70114-2458
US

IV. Provider business mailing address

7441 SEVEN OAKS RD
NEW ORLEANS LA
70128-2230
US

V. Phone/Fax

Practice location:
  • Phone: 504-931-6069
  • Fax:
Mailing address:
  • Phone: 504-931-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1245
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1245
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: