Healthcare Provider Details

I. General information

NPI: 1205793130
Provider Name (Legal Business Name): LEAGHA MARIE DENNISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W DANIELS ST
OZARK MO
65721-7322
US

IV. Provider business mailing address

500 W DANIELS ST
OZARK MO
65721-7322
US

V. Phone/Fax

Practice location:
  • Phone: 417-719-2057
  • Fax: 417-201-2152
Mailing address:
  • Phone: 417-719-2057
  • Fax: 417-201-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-494430
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: