Individual
KIMBERLY JULIET DEASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4201 N I 10 SERVICE RD W, METAIRIE, LA 70006
(504) 510-1804
Mailing address
3404 CARROLLTON WAY, JEFFERSON, LA 70121-2629
(504) 510-1804
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205321353
—
LA
Enumeration date
06/29/2018
Last updated
01/28/2019
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