Provider Demographics
NPI:1295396232
Name:NORWOOD, TALAYAH LA'AARIKA
Entity Type:Individual
Prefix:
First Name:TALAYAH
Middle Name:LA'AARIKA
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12672 BROOKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6804
Mailing Address - Country:US
Mailing Address - Phone:225-221-3019
Mailing Address - Fax:
Practice Address - Street 1:12672 BROOKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6804
Practice Address - Country:US
Practice Address - Phone:225-221-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011897050106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst