Individual
JODY LOWERY WALDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CIT
Contact information
Practice address
2000 FAIRFIELD AVE, SHREVEPORT, LA 71104-2099
(318) 222-8511
(318) 222-3273
Mailing address
2000 FAIRFIELD AVE, SHREVEPORT, LA 71104-2099
(318) 222-8511
(318) 222-3273
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4237
LA
Other
Enumeration date
04/18/2019
Last updated
04/18/2019
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