Provider Demographics
NPI:1871090522
Name:HAROLD, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HAROLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2343
Mailing Address - Country:US
Mailing Address - Phone:314-898-3504
Mailing Address - Fax:
Practice Address - Street 1:108 W. SOUTH STREET
Practice Address - Street 2:MORROW 125
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093
Practice Address - Country:US
Practice Address - Phone:660-543-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program