Healthcare Provider Details

I. General information

NPI: 1437860749
Provider Name (Legal Business Name): LEIGHA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5650 BROAD ST
SHIOCTON WI
54170-8626
US

IV. Provider business mailing address

N5650 BROAD ST
SHIOCTON WI
54170-8626
US

V. Phone/Fax

Practice location:
  • Phone: 920-986-3351
  • Fax:
Mailing address:
  • Phone: 920-986-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3001030014
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: