MEDICARE: KEYONNA TREADWAY

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	106S00000X	Behavior Technician	R-24511	LA

General Provider Information

NPI Number	:	1215884804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYONNA TREADWAY

Provider Business Mailing Address
First Line	:	1001 MAPLEWOOD DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 MAPLEWOOD DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-2946
Country	:	US
Telephone Number	:	318-750-8893
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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Directions to “ KEYONNA TREADWAY ” Practice Location

Language	Start Address	Practice Location

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