Provider Demographics
NPI:1619167426
Name:HEDGES, GRETCHEN B (SLP)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:B
Last Name:HEDGES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 MYRTLE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3065
Mailing Address - Country:US
Mailing Address - Phone:225-658-5387
Mailing Address - Fax:
Practice Address - Street 1:5207 MYRTLE HILL AVE
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3065
Practice Address - Country:US
Practice Address - Phone:225-658-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist