Healthcare Provider Details

I. General information

NPI: 1720224470
Provider Name (Legal Business Name): MAURINE T LADNER PH.D., MP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GEORGIA AVE
BOGALUSA LA
70427-3866
US

IV. Provider business mailing address

400 GEORGIA AVE
BOGALUSA LA
70427-3866
US

V. Phone/Fax

Practice location:
  • Phone: 985-732-6610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP-969
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number000969
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: