Healthcare Provider Details

I. General information

NPI: 1093294530
Provider Name (Legal Business Name): ALICIA KLEINPETER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8387 NEWFIELD DR
LIVONIA LA
70755-3605
US

IV. Provider business mailing address

6450 LOUISIANA HIGHWAY 1
BATCHELOR LA
70715
US

V. Phone/Fax

Practice location:
  • Phone: 225-637-2323
  • Fax: 225-637-2327
Mailing address:
  • Phone: 225-492-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14808
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: