Healthcare Provider Details

I. General information

NPI: 1821036344
Provider Name (Legal Business Name): LINNEA SUZANNE LEI ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N KENDRICK ST SUITE 4
FLAGSTAFF AZ
86001-1598
US

IV. Provider business mailing address

809 W RIORDAN RD SUITE 100, #326
FLAGSTAFF AZ
86001-0807
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-9123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3020
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: