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Individual

JACQUELINE LUTER CALLOWAY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1418 TIGER DR, THIBODAUX, LA 70301-4337
(985) 449-4055
Mailing address
130 SAXONY DR, HOUMA, LA 70364-2871
(228) 223-7968

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
9903
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
780830
LOUISIANA STATE BOARD OF PRACTICAL NURSING
LA
01
9903
LOUISIANA STATE BOARD OF SOCIAL WORK
LA
Enumeration date
03/06/2018
Last updated
06/16/2018
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