Individual
MRS. CASEY DANIELLE MENDIETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2285 BENTON RD STE C200, BOSSIER CITY, LA 71111-3554
(318) 741-5909
Mailing address
504 RUTLEDGE ST, SHREVEPORT, LA 71106-7825
(318) 550-7541
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
R-9261
LA
Other
Enumeration date
07/13/2021
Last updated
07/13/2021
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