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General NPI Number Information
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NPI Number | 1073166047
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Entity Type | Individual
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Provider Name | CACIQUE CARDE' AMBEAU M.S., SLP-A
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Gender | Female
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 6116 REIGER AVE
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City | DALLAS
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State | TX
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Zip | 75214-4599
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Country | US
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Telephone | 972-502-8964
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MORGAN AVE APT 3003
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City | DALLAS
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State | TX
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Zip | 75203-1043
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Country | US
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Telephone | 504-206-0340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 42350
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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