Provider Demographics
NPI:1528387230
Name:LOUISIANA EARLY INTERVENTION SPECIALISTS
Entity Type:Organization
Organization Name:LOUISIANA EARLY INTERVENTION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:318-758-2728
Mailing Address - Street 1:22173 HIGHWAY 124
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-7827
Mailing Address - Country:US
Mailing Address - Phone:318-758-2728
Mailing Address - Fax:318-339-4726
Practice Address - Street 1:22173 HIGHWAY 124
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71343-7827
Practice Address - Country:US
Practice Address - Phone:318-758-2728
Practice Address - Fax:318-339-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40207533K252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency