Provider Demographics
NPI:1891892287
Name:HARGRAVE, ALLISON CAMPO
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:CAMPO
Last Name:HARGRAVE
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 1:224 ST LANDRY ST
Mailing Address - Street 2:STE 2B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506
Mailing Address - Country:US
Mailing Address - Phone:337-235-4554
Mailing Address - Fax:337-235-4556
Practice Address - Street 1:224 ST LANDRY ST
Practice Address - Street 2:STE 2B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506
Practice Address - Country:US
Practice Address - Phone:337-235-4554
Practice Address - Fax:337-235-4556
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14022R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist