Provider Demographics
NPI:1194223032
Name:BENNETT, ALLISON RENE' (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENE'
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 ESPERANZA DR
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-6215
Mailing Address - Country:US
Mailing Address - Phone:225-636-8353
Mailing Address - Fax:
Practice Address - Street 1:11607 SOUTHFORK AVE STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5220
Practice Address - Country:US
Practice Address - Phone:225-636-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-573103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst