Provider Demographics
NPI:1346397098
Name:GAGNON, LEAH SUSAN (MA, ATC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:SUSAN
Last Name:GAGNON
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 CAMBRIDGE CLUB CIR
Mailing Address - Street 2:APT. 105
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9252
Mailing Address - Country:US
Mailing Address - Phone:920-242-0961
Mailing Address - Fax:
Practice Address - Street 1:2121 OAK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-8901
Practice Address - Country:US
Practice Address - Phone:734-998-8791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer