Provider Demographics
NPI:1447221494
Name:LEGNER, BERNARD LEO
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:LEO
Last Name:LEGNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 E HILLS CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-3657
Mailing Address - Country:US
Mailing Address - Phone:541-772-6722
Mailing Address - Fax:541-245-1530
Practice Address - Street 1:18 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7309
Practice Address - Country:US
Practice Address - Phone:541-772-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-0050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist