Provider Demographics
NPI:1720967243
Name:RHEAD, LEISA (MSW GRADUATE STUDENT)
Entity type:Individual
Prefix:
First Name:LEISA
Middle Name:
Last Name:RHEAD
Suffix:
Gender:F
Credentials:MSW GRADUATE STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 W MIRROR POND DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2275
Mailing Address - Country:US
Mailing Address - Phone:208-420-7154
Mailing Address - Fax:
Practice Address - Street 1:1065 E WINDING CREEK DR STE 250
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7246
Practice Address - Country:US
Practice Address - Phone:208-805-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program