=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992284764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ASHLEY GUZZARDO M.A. BCBA, LBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2018
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1019 N RANGE AVE STE B
-----------------------------------------------------
City | DENHAM SPRINGS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70726-2431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-791-0617
-----------------------------------------------------
Fax | 225-778-5439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7784 INNOVATION PARK DR
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70820-7006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-343-4232
-----------------------------------------------------
Fax | 225-343-4233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 695
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------