MEDICARE: JORDAN RUTH LELEUX

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1861356156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN RUTH LELEUX

Provider Business Mailing Address
First Line	:	5200 NELSON RD APT 502
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-0810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 NELSON RD APT 502
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-0810
Country	:	US
Telephone Number	:	337-240-1707
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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