Healthcare Provider Details

I. General information

NPI: 1447000641
Provider Name (Legal Business Name): KIRSTEN LEDDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 LINCOLN WAY
WHITE OAK PA
15131-1716
US

IV. Provider business mailing address

116 JAMES ST
NORTH VERSAILLES PA
15137-2022
US

V. Phone/Fax

Practice location:
  • Phone: 724-420-7143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026935
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: