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NPI Code Detail

MEDICARE: SAMANTHA BORDELON GREMILLION

MEDICARE: SAMANTHA BORDELON GREMILLION
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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
187-1687325OTHERLALLC

General Provider Information

NPI Number : 1144952433
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA BORDELON GREMILLION
Provider Business Mailing Address
First Line : 1663 KEED AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-8138
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1663 KEED AVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-8138
Country : US
Telephone Number : 318-359-4419
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2022
Last Update Date : 06/27/2022

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Directions to “ SAMANTHA BORDELON GREMILLION ” Practice Location

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