Provider Demographics
NPI:1114340346
Name:BONDE-LANGENFELD, LEAH M (MA)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:BONDE-LANGENFELD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1410
Mailing Address - Country:US
Mailing Address - Phone:920-286-2203
Mailing Address - Fax:
Practice Address - Street 1:615 S 8TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4463
Practice Address - Country:US
Practice Address - Phone:920-286-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2010-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional