MEDICARE: KASEY LEECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-16-22051

General Provider Information

NPI Number	:	1003279084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY LEECH

Provider Business Mailing Address
First Line	:	99 MAIN ST
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-2421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4664 LARWELL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3621
Country	:	US
Telephone Number	:	740-491-7702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2016
Last Update Date	:	05/23/2024

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Directions to “ KASEY LEECH ” Practice Location

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