Provider Demographics
NPI:1992841647
Name:LEGNON, LAURIE PATOUT (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:PATOUT
Last Name:LEGNON
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CLIPPER COVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-984-3810
Mailing Address - Fax:
Practice Address - Street 1:318 NORTH HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510
Practice Address - Country:US
Practice Address - Phone:337-893-6131
Practice Address - Fax:337-893-5527
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T323Medicare PIN