Healthcare Provider Details

I. General information

NPI: 1801001540
Provider Name (Legal Business Name): LEIGH SUZANNE YOUNG LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH RD
PORTLAND CT
06480-1554
US

IV. Provider business mailing address

1 ELIZABETH RD
PORTLAND CT
06480-1554
US

V. Phone/Fax

Practice location:
  • Phone: 203-630-5280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: