Healthcare Provider Details

I. General information

NPI: 1003985557
Provider Name (Legal Business Name): WILLIAM G. LEINO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILE 187 GLENN HIGHWAY
GLENNALLEN AK
99588-0589
US

IV. Provider business mailing address

PO BOX 5
GLENNALLEN AK
99588-0589
US

V. Phone/Fax

Practice location:
  • Phone: 907-822-3203
  • Fax: 907-822-5805
Mailing address:
  • Phone: 907-822-3203
  • Fax: 907-822-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number775
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: