Provider Demographics
NPI:1497105498
Name:WALDIE, LEAH ANN (BS)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:ANN
Last Name:WALDIE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6491
Mailing Address - Country:US
Mailing Address - Phone:715-831-0595
Mailing Address - Fax:
Practice Address - Street 1:3001 US HWY 12, E
Practice Address - Street 2:SUITE 160
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-3045
Practice Address - Country:US
Practice Address - Phone:715-232-1116
Practice Address - Fax:715-232-5987
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker