Provider Demographics
NPI:1497010706
Name:LEAH B. SCHOCK PHD, LLC
Entity Type:Organization
Organization Name:LEAH B. SCHOCK PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-678-5164
Mailing Address - Street 1:975 SW COLORADO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3155
Mailing Address - Country:US
Mailing Address - Phone:541-678-5164
Mailing Address - Fax:541-678-5017
Practice Address - Street 1:975 SW COLORADO AVE STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3155
Practice Address - Country:US
Practice Address - Phone:541-678-5164
Practice Address - Fax:541-678-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1492103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty