MEDICARE: MS. VICKI L LEACH

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1538844485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI L LEACH

Provider Business Mailing Address
First Line	:	41 GRAND AVE STE 102
Second Line	:
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-1947
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 GRAND AVE STE 102
Second Line	:
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-1947
Country	:	US
Telephone Number	:	855-412-1787
Fax Number	:

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

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/19/2023

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Directions to “ MS. VICKI L LEACH ” Practice Location

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