Provider Demographics
NPI:1316579899
Name:MORDAN, LEANNE E
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:E
Last Name:MORDAN
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 1:9900 GILMORE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47448-9731
Mailing Address - Country:US
Mailing Address - Phone:812-322-0313
Mailing Address - Fax:812-610-1814
Practice Address - Street 1:9900 GILMORE RIDGE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IN
Practice Address - Zip Code:47448-9731
Practice Address - Country:US
Practice Address - Phone:812-322-0313
Practice Address - Fax:812-610-1814
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician