Provider Demographics
NPI:1114771128
Name:CROCHET, AINSLEY
Entity Type:Individual
Prefix:
First Name:AINSLEY
Middle Name:
Last Name:CROCHET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 HIGHWAY 308
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-2105
Mailing Address - Country:US
Mailing Address - Phone:985-369-7251
Mailing Address - Fax:
Practice Address - Street 1:4901 HIGHWAY 308
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-2105
Practice Address - Country:US
Practice Address - Phone:985-369-7251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist