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General NPI Number Information
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NPI Number | 1932539350
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Entity Type | Individual
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Provider Name | KATHY DAVENPORT-CLARK
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Gender | Female
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Dates
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Enumeration Date | 11/21/2013
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 118 TOULINE ST
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City | NATCHITOCHES
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State | LA
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Zip | 71457
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Country | US
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Telephone | 318-379-4751
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Fax | 318-300-3772
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Provider Business Mailing Address
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Address Line | PO BOX 29372
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City | SHREVEPORT
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State | LA
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Zip | 71149-9372
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Country | US
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Telephone | 318-670-8898
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Fax | 318-476-2206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 8558
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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