Healthcare Provider Details

I. General information

NPI: 1376488387
Provider Name (Legal Business Name): DESTINEE LEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W VERMILION ST
LAFAYETTE LA
70501-6729
US

IV. Provider business mailing address

401 W VERMILION ST
LAFAYETTE LA
70501-6729
US

V. Phone/Fax

Practice location:
  • Phone: 337-345-6120
  • Fax:
Mailing address:
  • Phone: 337-345-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16685
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: