Provider Demographics
NPI:1750948089
Name:TELLIFERO, LEANN C
Entity type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:C
Last Name:TELLIFERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LEANN
Other - Middle Name:RUTH
Other - Last Name:CAVALLARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4606 LEE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71302-3235
Mailing Address - Country:US
Mailing Address - Phone:318-441-1105
Mailing Address - Fax:318-441-2251
Practice Address - Street 1:4606 LEE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71302-3235
Practice Address - Country:US
Practice Address - Phone:318-441-1105
Practice Address - Fax:318-441-2251
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator