Provider Demographics
NPI:1730123415
Name:KNIEPER, AUDRA J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:J
Last Name:KNIEPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13023 TOLLWAY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-7909
Mailing Address - Country:US
Mailing Address - Phone:225-278-5869
Mailing Address - Fax:225-756-5407
Practice Address - Street 1:3080 TEDDY DR STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1925
Practice Address - Country:US
Practice Address - Phone:225-278-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6767101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1007935Medicaid
LA5CU59Medicare PIN
LA4H882CU59Medicare UPIN