Provider Demographics
NPI:1316601826
Name:LAITINEN, JENNA (LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LAITINEN
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3469
Mailing Address - Country:US
Mailing Address - Phone:504-464-5949
Mailing Address - Fax:
Practice Address - Street 1:3635 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3469
Practice Address - Country:US
Practice Address - Phone:504-464-5949
Practice Address - Fax:504-464-5947
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4118225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist