Healthcare Provider Details

I. General information

NPI: 1336070085
Provider Name (Legal Business Name): LEIGHANN WARD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 WOODLAND BAYOU DR
SANTA ROSA BEACH FL
32459-3409
US

IV. Provider business mailing address

571 WOODLAND BAYOU DR
SANTA ROSA BEACH FL
32459-3409
US

V. Phone/Fax

Practice location:
  • Phone: 217-819-8988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: