Doctor Name: | JAKE CAVANAUGH |
NPI Number: | 1093078354 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | AUDIOLOGIST |
License Number: | |
Business Practice Address: | 1327 Stelly Ln Ste 3 Sulphur, LA - 706635641 |
Business Phone Number: | 3375287842 |
Business Fax Number: | 3374932014 |
Mailing Address: | 1327 Stelly Ln, Ste 3 SULPHUR |
State: | LA |
Postal Code: | 706635641 |
Phone Number: | 3375287842 |
Fax Number: | 3374932014 |
NPI Enumeration Date: | 06/21/2012 |
NPI Last Update Date: | 06/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |