Provider Demographics
NPI:1770767204
Name:HANEY, ASHLEY N
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:HANEY
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:PO BOX 15546
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-5546
Mailing Address - Country:US
Mailing Address - Phone:225-927-9109
Mailing Address - Fax:225-925-8001
Practice Address - Street 1:921 N LOBDELL AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8811
Practice Address - Country:US
Practice Address - Phone:225-927-9109
Practice Address - Fax:225-925-8001
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL20020171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator