Provider Demographics
NPI:1548409154
Name:LOCKETT, TERRENCE (CCC-L-SLP)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:LOCKETT
Suffix:
Gender:M
Credentials:CCC-L-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15403
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-5403
Mailing Address - Country:US
Mailing Address - Phone:225-205-0276
Mailing Address - Fax:877-580-7773
Practice Address - Street 1:18015 WILLOW ST.
Practice Address - Street 2:
Practice Address - City:GROSSE TETE
Practice Address - State:LA
Practice Address - Zip Code:70740
Practice Address - Country:US
Practice Address - Phone:225-648-3433
Practice Address - Fax:877-580-7773
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4929235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist