Leisa Dianne Ludlam, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0004705 Issued in FL

Practice address

4509 Woodbine Rd
Pace, FL 32571-8706

Phone

(850) 995-2500

Fax

(850) 995-2501

NPI assigned

Jun 25, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Leisa D. Ludlam, PH.D.,P.a.

  • Psychologist
  • Pace, FL
  • NPI 1295271443
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212624000000",
    "number": "1497781835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4509 WOODBINE RD",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325718706",
            "telephone_number": "850-995-2500",
            "fax_number": "850-995-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4509 WOODBINE RD",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325718706",
            "telephone_number": "850-995-2500",
            "fax_number": "850-995-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUDLAM",
        "first_name": "LEISA",
        "middle_name": "DIANNE",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2008-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0004705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Linville, RDN
• Jacob Daniel Lock, OD
• Matthew Lopez, PHARM D
• Sean Lowe
• Victor Scott Lowrimore, M.A.
• Nancy C Mackenzie, D.C.
• Brittany Mackey, OTR/L
• Teresa Ann Mahaffey, MD
• Kieara Mallory
• Jeannie Lynn Manke, ED.S.

• Clinical Psychologist in Pace, FL
• Providers in Pace, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.