Basic Information
| Provider Information | |||||||||
| NPI: | 1932539350 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVENPORT-CLARK | ||||||||
| FirstName: | KATHY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29372 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711499372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186708898 | ||||||||
| FaxNumber: | 3184762206 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 TOULINE ST | ||||||||
| Address2: | |||||||||
| City: | NATCHITOCHES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183794751 | ||||||||
| FaxNumber: | 3183003772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2013 | ||||||||
| LastUpdateDate: | 12/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 8558 | LA | N | Behavioral Health & Social Service Providers | Social Worker | School | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.