Provider Demographics
NPI:1508048794
Name:LEAHY, JOSHUA (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:LEAHY
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-708-7172
Mailing Address - Fax:206-913-2568
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-708-7172
Practice Address - Fax:206-913-2568
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003060171100000X
WANT00001607175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC00003060OtherACUPUNCTURIST
WANT00001607OtherNATUROPATH PHYSICIAN