Healthcare Provider Details

I. General information

NPI: 1538871892
Provider Name (Legal Business Name): AJA' LE'DACIA JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12628 HOOPER RD STE C
BATON ROUGE LA
70818-3527
US

IV. Provider business mailing address

12628 HOOPER RD STE C
BATON ROUGE LA
70818-3527
US

V. Phone/Fax

Practice location:
  • Phone: 225-953-8170
  • Fax:
Mailing address:
  • Phone: 225-953-8170
  • Fax: 225-953-8175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC10823
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: