Provider Demographics
NPI:1194172999
Name:GOUDEAU, CHARLOTTE MARIE (LM, CPM)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:GOUDEAU
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77900 JANIE LN
Mailing Address - Street 2:
Mailing Address - City:MARINGOUIN
Mailing Address - State:LA
Mailing Address - Zip Code:70757-3027
Mailing Address - Country:US
Mailing Address - Phone:225-776-0277
Mailing Address - Fax:
Practice Address - Street 1:77900 JANIE LN
Practice Address - Street 2:
Practice Address - City:MARINGOUIN
Practice Address - State:LA
Practice Address - Zip Code:70757-3027
Practice Address - Country:US
Practice Address - Phone:225-776-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301643176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife