Healthcare Provider Details

I. General information

NPI: 1720505076
Provider Name (Legal Business Name): AMY C ROCHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 AMESBURY DRIVE, APT 292
LAFAYETTE LA
70507
US

IV. Provider business mailing address

315 AMESBURY DR APT 292
LAFAYETTE LA
70507-3554
US

V. Phone/Fax

Practice location:
  • Phone: 678-761-5909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: