Provider Demographics
NPI:1407439904
Name:MICAH SPEAKS KID CAMP
Entity Type:Organization
Organization Name:MICAH SPEAKS KID CAMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-348-6807
Mailing Address - Street 1:201 JEFFREY DR APT 206G
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4566
Mailing Address - Country:US
Mailing Address - Phone:225-348-6807
Mailing Address - Fax:
Practice Address - Street 1:201 JEFFREY DR APT 206G
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4566
Practice Address - Country:US
Practice Address - Phone:225-348-6807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty