Healthcare Provider Details

I. General information

NPI: 1922939271
Provider Name (Legal Business Name): LUGENIA LEE REDDISH ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 PURPLE SAGE LN
PALMDALE CA
93550-8375
US

IV. Provider business mailing address

3305 PURPLE SAGE LN
PALMDALE CA
93550-8375
US

V. Phone/Fax

Practice location:
  • Phone: 661-341-1343
  • Fax:
Mailing address:
  • Phone: 661-341-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: