=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407743925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILLIAN C ELDRIDGE BS, LMSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2025
-----------------------------------------------------
Last Update Date | 06/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 102 INDEPENDENCE BLVD
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70506-6085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-473-2825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 SONATA XING
-----------------------------------------------------
City | DUSON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70529-3354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-230-5774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 13788
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------