Healthcare Provider Details

I. General information

NPI: 1386561819
Provider Name (Legal Business Name): LEANNE NICOLE WILLARD DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 S CHILSON ST
BAY CITY MI
48706-5219
US

IV. Provider business mailing address

1806 S CHILSON ST
BAY CITY MI
48706-5219
US

V. Phone/Fax

Practice location:
  • Phone: 989-225-2032
  • Fax:
Mailing address:
  • Phone: 989-225-2032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: