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NPI Code Detail

MEDICARE: KRISTINA DEZENDORF

MEDICARE: KRISTINA DEZENDORF
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 Worker17723LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700563574
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA DEZENDORF
Provider Business Mailing Address
First Line : 3415 GERLANDO DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70814-1109
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3415 GERLANDO DR
Second Line :
City : BATON ROUGE
State : LA
Zip : 70814-1109
Country : US
Telephone Number : 225-610-7400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2023
Last Update Date : 07/03/2023

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Directions to “ KRISTINA DEZENDORF ” Practice Location

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