Healthcare Provider Details

I. General information

NPI: 1124473947
Provider Name (Legal Business Name): LASHEGAL CANNON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 LAKE FOREST BLVD
NEW ORLEANS LA
70127-3043
US

IV. Provider business mailing address

3400 KENT AVE G303
METAIRIE LA
70006-3951
US

V. Phone/Fax

Practice location:
  • Phone: 504-418-8315
  • Fax:
Mailing address:
  • Phone: 504-418-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13212
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: