MEDICARE: LATESSA MATHEWS

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	104100000X	Social Worker	8023	LA
2	171M00000X	Case Manager/Care Coordinator		LA

General Provider Information

NPI Number	:	1982075560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATESSA MATHEWS

Provider Business Mailing Address
First Line	:	710 VERSAILLES BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2351
Country	:	US
Telephone Number	:	318-449-4474
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 BREVARD CT STE B
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-3997
Country	:	US
Telephone Number	:	318-238-4030
Fax Number	:

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	12/23/2022

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Directions to “ LATESSA MATHEWS ” Practice Location

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