Provider Demographics
NPI:1306208251
Name:LEBLANC, BRITTANY ANN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:LEBLANC
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 1:4474 N OAKLAND AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1667
Mailing Address - Country:US
Mailing Address - Phone:413-695-5093
Mailing Address - Fax:
Practice Address - Street 1:8239 W HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-3205
Practice Address - Country:US
Practice Address - Phone:414-229-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst