MEDICARE: DR. JODY M. LEACH PH.D.

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	103TC0700X	Clinical Psychologist	PSY 25826	CA

General Provider Information

NPI Number	:	1881850196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODY M. LEACH PH.D.

Provider Business Mailing Address
First Line	:	30 N ROOSEVELT AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3621
Country	:	US
Telephone Number	:	626-796-7511
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N ROOSEVELT AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3621
Country	:	US
Telephone Number	:	626-529-5415
Fax Number	:	626-628-1840

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

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	04/19/2016

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