Provider Demographics
NPI:1205033743
Name:LEGROS, ALISON Z (DT)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:Z
Last Name:LEGROS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:MRS
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:GAUTREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 SIOUX LN
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0327
Mailing Address - Country:US
Mailing Address - Phone:337-207-5482
Mailing Address - Fax:
Practice Address - Street 1:1602 W PINHOOK RD
Practice Address - Street 2:SUITE 204
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3735
Practice Address - Country:US
Practice Address - Phone:337-207-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1059133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered