Provider Demographics
NPI:1093859977
Name:JEFFERSON, LOUANNE MARIE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:LOUANNE
Middle Name:MARIE
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:4000 NORFOLK CT
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0619
Mailing Address - Country:US
Mailing Address - Phone:517-353-4369
Mailing Address - Fax:517-432-2137
Practice Address - Street 1:MICHIGAN STATE UNIVERSITY DEPT OF ATHLETICS
Practice Address - Street 2:#131 DUFFY DAUGHERTY FB BLDG
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1214
Practice Address - Country:US
Practice Address - Phone:517-353-4369
Practice Address - Fax:517-432-2137
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer