Provider Demographics
NPI:1366847972
Name:PECK, LEEANN (BCBA)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:PECK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-2823
Mailing Address - Country:US
Mailing Address - Phone:573-253-9095
Mailing Address - Fax:
Practice Address - Street 1:7027 BARTH RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3535
Practice Address - Country:US
Practice Address - Phone:913-777-9718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst