Healthcare Provider Details

I. General information

NPI: 1144795733
Provider Name (Legal Business Name): ASHLEY A VALLAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 WOODDALE BLVD STE A
BATON ROUGE LA
70805-7567
US

IV. Provider business mailing address

PO BOX 66558
BATON ROUGE LA
70896-6558
US

V. Phone/Fax

Practice location:
  • Phone: 225-925-1906
  • Fax: 225-362-5314
Mailing address:
  • Phone: 225-925-4282
  • Fax: 225-362-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10278
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10278
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: