Healthcare Provider Details

I. General information

NPI: 1720719180
Provider Name (Legal Business Name): JENNIFER LADD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 BLUEBONNET BLVD STE A
BATON ROUGE LA
70810-2982
US

IV. Provider business mailing address

9239 BLUEBONNET BLVD STE A
BATON ROUGE LA
70810-2982
US

V. Phone/Fax

Practice location:
  • Phone: 225-255-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC9038
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: