Provider Demographics
NPI:1073910329
Name:LEISINGER, JOLYNN
Entity Type:Individual
Prefix:
First Name:JOLYNN
Middle Name:
Last Name:LEISINGER
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:PO BOX 1362
Mailing Address - Street 2:670 EAST HALL AVE
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4935 OLD POST RD
Practice Address - Street 2:68
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4360
Practice Address - Country:US
Practice Address - Phone:307-699-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer