MEDICARE: COURTNEY JEAN CARROLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	14439635	LA

General Provider Information

NPI Number	:	1982548566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JEAN CARROLL

Provider Business Mailing Address
First Line	:	18514 DOC OLENA DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-0705
Country	:	US
Telephone Number	:	504-914-3617
Fax Number	:	504-914-3617

Provider Business Practice Location Address
First Line	:	625 S BURNSIDE AVE
Second Line	:	SUITE 2
City	:	GONZALES
State	:	LA
Zip	:	70737-3400
Country	:	US
Telephone Number	:	225-437-9535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ COURTNEY JEAN CARROLL ” Practice Location

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