Provider Demographics
NPI:1386041630
Name:LEEPER, ANITA LORRAINE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LORRAINE
Last Name:LEEPER
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 1:5408 83RD STREET CT SW
Mailing Address - Street 2:O104
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2998
Mailing Address - Country:US
Mailing Address - Phone:253-324-3677
Mailing Address - Fax:
Practice Address - Street 1:5408 83RD STREET CT SW
Practice Address - Street 2:O104
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2998
Practice Address - Country:US
Practice Address - Phone:253-324-3677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC603041061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical