MEDICARE: KALESHA GABRIELLE LEDLOW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1053851816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALESHA GABRIELLE LEDLOW

Provider Business Mailing Address
First Line	:	2525 YOUREE DR STE 110
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3600
Country	:	US
Telephone Number	:	318-742-3408
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 W REED RD STE A-1
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-6967
Country	:	US
Telephone Number	:	662-702-5108
Fax Number	:

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

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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