MEDICARE: LEAH AUSTAD MS

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	1290-226	WI

General Provider Information

NPI Number	:	1184969032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH AUSTAD MS

Provider Business Mailing Address
First Line	:	1802 WARDEN ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-4960
Country	:	US
Telephone Number	:	715-552-1620
Fax Number	:	715-552-2734

Provider Business Practice Location Address
First Line	:	1802 WARDEN ST
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54703-4960
Country	:	US
Telephone Number	:	715-552-1620
Fax Number	:	715-552-2734

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

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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Directions to “ LEAH AUSTAD MS” Practice Location

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