Healthcare Provider Details

I. General information

NPI: 1932230646
Provider Name (Legal Business Name): TONI LYNNETTE LEUER EARLY INTERVENTION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CHURCHILL DOWNS DR
BUSH LA
70431-4605
US

IV. Provider business mailing address

105 CHURCHILL DOWNS DR
BUSH LA
70431-4605
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-3635
  • Fax: 985-898-3635
Mailing address:
  • Phone: 985-898-3635
  • Fax: 985-898-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: