Provider Demographics
NPI:1255481842
Name:NARUS, LEONARD RAYMOND JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:RAYMOND
Last Name:NARUS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N53W30465 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1028
Mailing Address - Country:US
Mailing Address - Phone:262-367-8326
Mailing Address - Fax:262-367-6488
Practice Address - Street 1:N53W30465 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-1028
Practice Address - Country:US
Practice Address - Phone:262-367-8326
Practice Address - Fax:262-367-6488
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI917103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39078400Medicaid
WIB 88634Medicare ID - Type Unspecified
WI39078400Medicaid