Healthcare Provider Details

I. General information

NPI: 1306361654
Provider Name (Legal Business Name): JODI LADUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SAXONY RD STE 203
ENCINITAS CA
92024-6780
US

IV. Provider business mailing address

169 SAXONY RD STE 203
ENCINITAS CA
92024-6780
US

V. Phone/Fax

Practice location:
  • Phone: 760-496-8941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: