Provider Demographics
NPI:1467893123
Name:LEVENGOOD, LEO JERROLD
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:JERROLD
Last Name:LEVENGOOD
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 1:1013 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3269
Mailing Address - Country:US
Mailing Address - Phone:307-274-7850
Mailing Address - Fax:
Practice Address - Street 1:1013 E 24TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3269
Practice Address - Country:US
Practice Address - Phone:307-274-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator