Individual
TAMMY LEDET GUILLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HAIR LOSS SPECIALIST
Contact information
Practice address
1323 12TH ST, LAKE CHARLES, LA 70601-6377
(337) 240-8454
Mailing address
1323 12TH ST, LAKE CHARLES, LA 70601-6377
(337) 240-8454
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
L440541002
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1744P3200X
CERTIFIED HAIR LOSS SPECIALIST
LA
Enumeration date
02/04/2019
Last updated
02/04/2019
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