Healthcare Provider Details

I. General information

NPI: 1215705207
Provider Name (Legal Business Name): MADISON LEDOUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 CROWLEY RAYNE HWY
CROWLEY LA
70526-8209
US

IV. Provider business mailing address

2000 OPELOUSAS ST
LAKE CHARLES LA
70601-2641
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-5519
  • Fax:
Mailing address:
  • Phone: 337-439-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3687
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: