Provider Demographics
NPI:1952673378
Name:OPDENHOFF, JANET LECKIE (LMT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LECKIE
Last Name:OPDENHOFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5020
Mailing Address - Country:US
Mailing Address - Phone:318-623-0439
Mailing Address - Fax:
Practice Address - Street 1:110 HUDSON ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5020
Practice Address - Country:US
Practice Address - Phone:318-623-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA #5503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist