Provider Demographics
NPI:1407305410
Name:GERVAIS, ASHLEY RENEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:RENEE
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 HOUMA BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2940
Mailing Address - Country:US
Mailing Address - Phone:504-889-5335
Mailing Address - Fax:
Practice Address - Street 1:4315 HOUMA BLVD
Practice Address - Street 2:STE 401
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2940
Practice Address - Country:US
Practice Address - Phone:504-889-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7118237600000X
MSA3910237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSA3910OtherMISSISSIPPI DEPARTMENT OF HEALTH
LA7118OtherSTATE OF LA