MEDICARE: LEAH C MCCANN

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	101YP2500X	Professional Counselor	8840	WI

General Provider Information

NPI Number	:	1013862861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH C MCCANN

Provider Business Mailing Address
First Line	:	6025 N GREEN BAY AVE UPPR LEVEL
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3702
Country	:	US
Telephone Number	:	414-247-0801
Fax Number	:	414-247-0816

Provider Business Practice Location Address
First Line	:	6025 N GREEN BAY AVE UPPR LEVEL
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3702
Country	:	US
Telephone Number	:	414-247-0801
Fax Number	:	414-247-0816

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

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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Directions to “ LEAH C MCCANN ” Practice Location

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