Healthcare Provider Details

I. General information

NPI: 1447461165
Provider Name (Legal Business Name): LESLIE L SCHUCH MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E CLAIREMONT AVE
EAU CLAIRE WI
54701-3685
US

IV. Provider business mailing address

431 E CLAIREMONT AVE
EAU CLAIRE WI
54701-3685
US

V. Phone/Fax

Practice location:
  • Phone: 715-831-6283
  • Fax:
Mailing address:
  • Phone: 715-831-6283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: