Provider Demographics
NPI:1790343440
Name:CANTRELL, ALICIA ANN
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANN
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALICIA
Other - Middle Name:ANN
Other - Last Name:IRVING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:714 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2092
Mailing Address - Country:US
Mailing Address - Phone:601-316-2816
Mailing Address - Fax:
Practice Address - Street 1:50 PINECREST DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4283
Practice Address - Country:US
Practice Address - Phone:318-640-9656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist