MEDICARE: ANNA LEDBETTER

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	:	1578447884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA LEDBETTER

Provider Business Mailing Address
First Line	:	2421 CORPORATE CTR STE 100
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4195
Country	:	US
Telephone Number	:	618-589-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 CORPORATE CTR
Second Line	:	SUITE 100
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-4195
Country	:	US
Telephone Number	:	618-589-5165
Fax Number	:

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

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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Directions to “ ANNA LEDBETTER ” Practice Location

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