Provider Demographics
NPI:1356121537
Name:WINDHAM, ANNA
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:WINDHAM
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 1:650 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-2821
Mailing Address - Country:US
Mailing Address - Phone:337-396-4817
Mailing Address - Fax:
Practice Address - Street 1:1001 ASHLAND RD
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-9035
Practice Address - Country:US
Practice Address - Phone:318-271-3166
Practice Address - Fax:318-932-9289
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA134861041C0700X
LAAN5631711041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool