Healthcare Provider Details

I. General information

NPI: 1962693580
Provider Name (Legal Business Name): BRENDA TRIPPLETT RANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA T. RANEY MSW

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 3RD ST
FT. POLK LA
71459
US

IV. Provider business mailing address

912 MILL ST
OAKDALE LA
71463-3449
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3118
  • Fax:
Mailing address:
  • Phone: 318-335-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801065544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: