MEDICARE: THERESE KIRKPATRICK I LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	010557591	LA
2	104100000X	Social Worker	15656	LA

General Provider Information

NPI Number	:	1003317637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE KIRKPATRICK I LMSW

Provider Business Mailing Address
First Line	:	1304 BERTRAND DR STE E3
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-9105
Country	:	US
Telephone Number	:	337-962-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 BERTRAND DR STE E3
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70506-9105
Country	:	US
Telephone Number	:	337-962-1987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/11/2025

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Directions to “ THERESE KIRKPATRICK I LMSW” Practice Location

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