| Entity Name: | LEISA D. LUDLAM, PH.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 Jul 2002 (23 years ago) |
| Document Number: | P02000074154 |
| FEI/EIN Number | 611434566 |
| Address: | 4509 WOODBINE RD, PACE, FL, 32571 |
| Mail Address: | 4509 WOODBINE RD, PACE, FL, 32571 |
| ZIP code: | 32571 |
| County: | Santa Rosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295271443 | 2017-01-12 | 2017-01-12 | 4509 WOODBINE RD, PACE, FL, 325718706, US | 4509 WOODBINE RD, PACE, FL, 325718706, US | |||||||||||||||||||
|
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| Phone | +1 850-995-2500 |
| Fax | 8509952501 |
Authorized person
| Name | DR. LEISA D LUDLAM |
| Role | OWNER |
| Phone | 8509952500 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| License Number | PY4705 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| LUDLAM LEISA D | Agent | 4509 WOODBINE RD, PACE, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| LUDLAM LEISA D | President | 4509 WOODBINE RD, PACE, FL, 32571 |
| Name | Role | Address |
|---|---|---|
| LUDLAM LEISA D | Director | 4509 WOODBINE RD, PACE, FL, 32571 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-28 | 4509 WOODBINE RD, PACE, FL 32571 | No data |
| CHANGE OF MAILING ADDRESS | 2008-01-28 | 4509 WOODBINE RD, PACE, FL 32571 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-01-28 | 4509 WOODBINE RD, PACE, FL 32571 | No data |
| REGISTERED AGENT NAME CHANGED | 2004-05-05 | LUDLAM, LEISA D | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-14 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-04-16 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-02-21 |
| ANNUAL REPORT | 2017-09-20 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
