Provider Demographics
NPI:1003321241
Name:LECLAIR, TATIANA (RBT)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SE DELAWARE AVE STE O
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4011
Mailing Address - Country:US
Mailing Address - Phone:515-261-2402
Mailing Address - Fax:515-414-7642
Practice Address - Street 1:1555 SE DELAWARE AVE STE O
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4011
Practice Address - Country:US
Practice Address - Phone:515-261-2402
Practice Address - Fax:515-414-7642
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherPRIVATE INSURANCE