Provider Demographics
NPI:1104080084
Name:LANDRY, ASHLEY BLAIR (MA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:BLAIR
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:BLAIR
Other - Middle Name:H
Other - Last Name:LANDRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:4451 BLUEBONNET BLVD, STE G
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-663-6130
Mailing Address - Fax:225-757-6559
Practice Address - Street 1:4451 BLUEBONNET BLVD
Practice Address - Street 2:STE G
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809
Practice Address - Country:US
Practice Address - Phone:225-663-6130
Practice Address - Fax:225-757-6559
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5262231H00000X
LA5262231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist