Healthcare Provider Details

I. General information

NPI: 1063933737
Provider Name (Legal Business Name): SARAH ANN LEACH LICSW, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 MARTIN LUTHER KING JR WAY MARCONI CHIROPRACTIC & W
TACOMA WA
98405
US

IV. Provider business mailing address

171 CHESTNUT ST STE 200
PROVIDENCE RI
02903-4604
US

V. Phone/Fax

Practice location:
  • Phone: 253-750-3381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberISW04024
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61392155
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119449
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: