Provider Demographics
NPI:1003464835
Name:LEITER, REBECCA ANN
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:LEITER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1349 YOUNGS RD
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MI
Mailing Address - Zip Code:48865-9738
Mailing Address - Country:US
Mailing Address - Phone:616-329-6030
Mailing Address - Fax:
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-8601
Practice Address - Country:US
Practice Address - Phone:989-372-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst