MEDICARE: MRS. SHANNON HAWKINS RAGUSA LPC

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	101YP2500X	Professional Counselor	2767	LA

General Provider Information

NPI Number	:	1770306615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON HAWKINS RAGUSA LPC

Provider Business Mailing Address
First Line	:	4045 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3830
Country	:	US
Telephone Number	:	225-268-0045
Fax Number	:	225-387-7670

Provider Business Practice Location Address
First Line	:	4045 NORTH BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3830
Country	:	US
Telephone Number	:	122-526-8004
Fax Number	:	225-387-7670

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

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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