Provider Demographics
NPI:1043811193
Name:BENZ, LEAH MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:BENZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3149 KOSCHNICK RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-9415
Mailing Address - Country:US
Mailing Address - Phone:262-490-0644
Mailing Address - Fax:
Practice Address - Street 1:W3149 KOSCHNICK RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-9415
Practice Address - Country:US
Practice Address - Phone:262-490-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8004-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional