Individual
DESIREE THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20 THE RAYS TRL SE, BOGUE CHITTO, MS 39629-8500
(601) 833-8363
Mailing address
607 CASE TRL NW, BROOKHAVEN, MS 39601-9061
(601) 757-5506
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2846
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07427004
—
MS
Enumeration date
04/26/2007
Last updated
07/09/2007
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