MEDICARE: MS. LESLIE ANN HABENICHT CD(DONA), LLSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1407143522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE ANN HABENICHT CD(DONA), LLSS

Provider Business Mailing Address
First Line	:	10105 CLEARMEADOW DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-1519
Country	:	US
Telephone Number	:	214-343-0822
Fax Number	:

Provider Business Practice Location Address
First Line	:	10105 CLEARMEADOW DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-1519
Country	:	US
Telephone Number	:	214-343-0822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2011
Last Update Date	:	07/10/2011

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