Healthcare Provider Details

I. General information

NPI: 1740801265
Provider Name (Legal Business Name): LUCAS LEITNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NE MAPLE ST
PULLMAN WA
99163-4120
US

IV. Provider business mailing address

340 NE MAPLE ST
PULLMAN WA
99163-4120
US

V. Phone/Fax

Practice location:
  • Phone: 509-334-1133
  • Fax: 509-332-6018
Mailing address:
  • Phone: 509-334-1133
  • Fax: 509-332-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: