MEDICARE: JERAD LEISCH

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	106S00000X	Behavior Technician	RBT-20-149038	WY

General Provider Information

NPI Number	:	1710574801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERAD LEISCH

Provider Business Mailing Address
First Line	:	310 E BROADWAY AVE
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8636
Country	:	US
Telephone Number	:	307-212-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	2632 FOOTHILL BLVD
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4756
Country	:	US
Telephone Number	:	307-212-3284
Fax Number	:

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

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

Similar Medicare Providers

1588720684 — DR. TY CHARLES QUICKENDEN D.C.
Practice Location Address:

2632 FOOTHILL BLVD , SUITE 107
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-362-7900
Practice Fax: 307-362-8230

1982759205 — MRS. KARLA ANN CARNAHAN M.S., CCC, SLP-L
Practice Location Address:

2632 FOOTHILL BLVD , SUITE 104
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-389-7434
Practice Fax:

1609043223 — DR. LARRY JAMES CARLSON PH.D
Practice Location Address:

2632 FOOTHILL BLVD , SUITE 106
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-362-8840
Practice Fax: 307-362-8840

1578706941 — TY C. QUICKENDEN CHIROPRACTIC, P.C.
Practice Location Address:

2632 FOOTHILL BLVD , SUITE 107
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-362-7900
Practice Fax: 307-362-8230

1154945400 — ASHTEN ZUEHLSDORFF
Practice Location Address:

2632 FOOTHILL BLVD
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-705-3004
Practice Fax:

1245848001 — JESSIE LOCKWOOD WILLOUGHBY
Practice Location Address:

2632 FOOTHILL BLVD
ROCK SPRINGS, WY
82901-4756

Practice Phone: 307-723-2520
Practice Fax:

Directions to “ JERAD LEISCH ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.