MEDICARE: MARISSA LEININGER

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1952760597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LEININGER

Provider Business Mailing Address
First Line	:	5344 POLIZZE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4525 S SANDHILL RD
Second Line	:	STE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5954
Country	:	US
Telephone Number	:	702-741-1938
Fax Number	:

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

Provider Enumeration Date	:	02/10/2016
Last Update Date	:	02/10/2016

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Directions to “ MARISSA LEININGER ” Practice Location

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