Provider Demographics
NPI:1578447884
Name:LEDBETTER, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LEDBETTER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 CORPORATE CTR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4195
Mailing Address - Country:US
Mailing Address - Phone:618-589-5165
Mailing Address - Fax:
Practice Address - Street 1:2124 CORPORATE CTR
Practice Address - Street 2:SUITE 100
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4195
Practice Address - Country:US
Practice Address - Phone:618-589-5165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician