MEDICARE: LATEJLA JOHNSON

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	1041C0700X	Clinical Social Worker		LA
2	171M00000X	Case Manager/Care Coordinator	19373	LA

General Provider Information

NPI Number	:	1295615730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATEJLA JOHNSON

Provider Business Mailing Address
First Line	:	350 MAIN ST
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-3767
Country	:	US
Telephone Number	:	225-778-6783
Fax Number	:

Provider Business Practice Location Address
First Line	:	12097 OLD HAMMOND HWY STE I4
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-8679
Country	:	US
Telephone Number	:	225-246-8816
Fax Number	:

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

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	02/07/2026

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