Healthcare Provider Details

I. General information

NPI: 1396273462
Provider Name (Legal Business Name): SHANDA LANGFORD CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8326 KELWOOD AVE
BATON ROUGE LA
70806-4803
US

IV. Provider business mailing address

1000 CHINABERRY DR STE 900
BOSSIER CITY LA
71111-2455
US

V. Phone/Fax

Practice location:
  • Phone: 225-665-7878
  • Fax: 225-665-7856
Mailing address:
  • Phone: 318-459-6795
  • Fax: 318-626-5429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5208
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: