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NPI Code Detail

MEDICARE: MS. JANIS KAYE IVEY LCSW

MEDICARE: MS. JANIS KAYE IVEY LCSW
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 Worker3787LA

General Provider Information

NPI Number : 1205021219
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANIS KAYE IVEY LCSW
Provider Business Mailing Address
First Line : 8275 VINCENT RD APT 902
Second Line :
City : DENHAM SPRINGS
State : LA
Zip : 70726-6270
Country : US
Telephone Number : 225-802-1361
Fax Number :
Provider Business Practice Location Address
First Line : 1024 E ASCENSION COMPLEX BLVD
Second Line :
City : GONZALES
State : LA
Zip : 70737-4263
Country : US
Telephone Number : 225-644-4582
Fax Number : 225-644-3635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2007
Last Update Date : 07/28/2009

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