Healthcare Provider Details

I. General information

NPI: 1033602776
Provider Name (Legal Business Name): CLINICAL STICKS ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WESTMARK BLVD BLDG STE 2A
LAFAYETTE LA
70506-7344
US

IV. Provider business mailing address

1 GALLERIA BLVD STE 1900
METAIRIE LA
70001-7553
US

V. Phone/Fax

Practice location:
  • Phone: 337-595-5116
  • Fax: 800-541-8319
Mailing address:
  • Phone: 504-656-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHANNE GILBERT
Title or Position: OWNER
Credential:
Phone: 337-595-5116