Provider Demographics
NPI:1407016843
Name:ELSWICK, LEANN (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:ELSWICK
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:
Other - Last Name:ELSWICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-218-2256
Mailing Address - Fax:606-218-6577
Practice Address - Street 1:131 SUMMIT DR FL 3
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1580
Practice Address - Country:US
Practice Address - Phone:606-218-2256
Practice Address - Fax:606-218-6577
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY252065103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33653OtherBCBA CERTIFICATE