Provider Demographics
NPI:1487985461
Name:POWELL, KELLEY AINSWORTH (MCD, CCC-A)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:AINSWORTH
Last Name:POWELL
Suffix:
Gender:F
Credentials:MCD, CCC-A
Other - Prefix:MISS
Other - First Name:KELLEY
Other - Middle Name:LEA
Other - Last Name:AINSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CCC-A
Mailing Address - Street 1:11903 COURSEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4662
Mailing Address - Country:US
Mailing Address - Phone:225-769-9530
Mailing Address - Fax:225-769-9529
Practice Address - Street 1:13702 COURSEY BLVD STE 10C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1370
Practice Address - Country:US
Practice Address - Phone:225-769-9530
Practice Address - Fax:225-769-9529
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3925231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2126300Medicaid
MS07885060Medicaid
LA2126300Medicaid