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General NPI Number Information
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NPI Number | 1558624890
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Entity Type | Individual
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Provider Name | JACLYN E.A. LEGG D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 4121 W 83RD ST STE 254
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5303
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Country | US
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Telephone | 913-291-0076
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Fax | 913-951-0656
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Provider Business Mailing Address
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Address Line | 4121 W 83RD ST STE 254
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5303
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Country | US
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Telephone | 913-291-0076
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Fax | 913-951-0656
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0539323
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0539323
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License Number State | KS
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