MEDICARE: LEANN LEACH MSW LCSW

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	1548	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922030758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANN LEACH MSW LCSW

Provider Business Mailing Address
First Line	:	2660 BOBWHITE TRAIL
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025
Country	:	US
Telephone Number	:	405-340-8260
Fax Number	:	405-341-0049

Provider Business Practice Location Address
First Line	:	2660 BOBWHITE TRAIL
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025
Country	:	US
Telephone Number	:	405-340-8260
Fax Number	:	405-341-0049

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/28/2010

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