Provider Demographics
NPI:1295044303
Name:LECLAIR, JEFFREY PAUL (PSYD, PA-C)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:LECLAIR
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Gender:M
Credentials:PSYD, PA-C
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Mailing Address - Street 1:1011 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:MO
Mailing Address - Zip Code:65712-1331
Mailing Address - Country:US
Mailing Address - Phone:417-466-7191
Mailing Address - Fax:417-466-3876
Practice Address - Street 1:1011 SOUTH EAST STREET
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:MO
Practice Address - Zip Code:65712
Practice Address - Country:US
Practice Address - Phone:417-466-7191
Practice Address - Fax:417-466-3876
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2016-10-05
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Provider Licenses
StateLicense IDTaxonomies
MO2011002799363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant