MEDICARE: SPECIAL D VENTROY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	19214	LA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1194532325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPECIAL D VENTROY

Provider Business Mailing Address
First Line	:	827 FAIRMONT LN
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-1911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	827 FAIRMONT LN
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-1911
Country	:	US
Telephone Number	:	337-789-2441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	03/18/2026

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Directions to “ SPECIAL D VENTROY ” Practice Location

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