MEDICARE: LEAH ALLEN LCSW LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1912691502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAH ALLEN LCSW LLC

Provider Business Mailing Address
First Line	:	63159 BOYD ACRES RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-8516
Country	:	US
Telephone Number	:	541-854-5324
Fax Number	:

Provider Business Practice Location Address
First Line	:	21760 LOS SERRANOS DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-9533
Country	:	US
Telephone Number	:	541-854-5324
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	LEAH ALLEN
Credential	:	LCSW
Telephone Number	:	541-854-5324

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	05/12/2025

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