Provider Demographics
NPI:1285037192
Name:KEVAL, LEAH DAVIS (LCSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:DAVIS
Last Name:KEVAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KATHRYN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2416 DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:SAUKVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53080-2438
Mailing Address - Country:US
Mailing Address - Phone:414-534-2783
Mailing Address - Fax:
Practice Address - Street 1:1126 S 70TH ST STE 112-3
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3124
Practice Address - Country:US
Practice Address - Phone:414-727-2789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000769101YA0400X
CO00009920539104100000X
COCSW.099245331041C0700X
WI8817-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8817-123OtherWISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI8817-123Medicaid