Provider Demographics
NPI:1467968990
Name:BICKNELL, LEAH M (LAC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:BICKNELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22311 E MERLOT ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9034
Mailing Address - Country:US
Mailing Address - Phone:480-861-6351
Mailing Address - Fax:
Practice Address - Street 1:3225 N 75TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6909
Practice Address - Country:US
Practice Address - Phone:480-429-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0920171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist