Provider Demographics
NPI:1326485707
Name:WONG, LEIGHANN S (PHD)
Entity Type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:S
Last Name:WONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8359 BEACON BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3066
Mailing Address - Country:US
Mailing Address - Phone:239-599-5656
Mailing Address - Fax:239-599-5655
Practice Address - Street 1:8359 BEACON BLVD STE 503
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-599-5656
Practice Address - Fax:239-599-5655
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-26
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical