Provider Demographics
NPI:1437818267
Name:LASISI, TAWAKALITU O (SWT)
Entity Type:Individual
Prefix:
First Name:TAWAKALITU
Middle Name:O
Last Name:LASISI
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13943 CHALMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2192
Mailing Address - Country:US
Mailing Address - Phone:740-589-0867
Mailing Address - Fax:
Practice Address - Street 1:13943 CHALMETTE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-2192
Practice Address - Country:US
Practice Address - Phone:405-890-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker