Provider Demographics
NPI:1346767415
Name:HOAGLAND, LEANNE KATHRYN (LAC)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:KATHRYN
Last Name:HOAGLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-0095
Mailing Address - Country:US
Mailing Address - Phone:406-939-1263
Mailing Address - Fax:
Practice Address - Street 1:119 S KENDRICK AVE
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1626
Practice Address - Country:US
Practice Address - Phone:406-939-1263
Practice Address - Fax:406-939-1263
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-24776101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)