Provider Demographics
NPI:1164169652
Name:LEAVITT-KIRKLAND, HAYLEE
Entity Type:Individual
Prefix:
First Name:HAYLEE
Middle Name:
Last Name:LEAVITT-KIRKLAND
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 1:2424 W CALVIN DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8481
Mailing Address - Country:US
Mailing Address - Phone:417-352-2685
Mailing Address - Fax:
Practice Address - Street 1:2424 W CALVIN DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8481
Practice Address - Country:US
Practice Address - Phone:417-352-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021046209104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker