Provider Demographics
NPI:1629539747
Name:WASHINGTON, RENODA B
Entity Type:Individual
Prefix:
First Name:RENODA
Middle Name:B
Last Name:WASHINGTON
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 1:1202 KIRKMAN ST STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5391
Mailing Address - Country:US
Mailing Address - Phone:337-990-5305
Mailing Address - Fax:
Practice Address - Street 1:1202 KIRKMAN ST STE C
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5391
Practice Address - Country:US
Practice Address - Phone:337-990-5305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator