Provider Demographics
NPI:1265001887
Name:LEACH, ERIN
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:LEACH
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 1:629 S MINNESOTA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-4875
Mailing Address - Country:US
Mailing Address - Phone:605-941-7174
Mailing Address - Fax:
Practice Address - Street 1:2040 W MAIN ST STE 312
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2447
Practice Address - Country:US
Practice Address - Phone:605-941-7174
Practice Address - Fax:605-231-4312
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist