MEDICARE: MISS LEAH DANIELLE DUNN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1558971465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LEAH DANIELLE DUNN

Provider Business Mailing Address
First Line	:	149 BROOKWOOD AVE NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-4402
Country	:	US
Telephone Number	:	828-460-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	8307 UNIVERSITY EXEC PARK DR STE 231
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-1381
Country	:	US
Telephone Number	:	704-894-9678
Fax Number	:

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

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	08/05/2020

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