Provider Demographics
NPI:1508135781
Name:IRELAND, LEONETTE ANN (LSW LADC)
Entity Type:Individual
Prefix:
First Name:LEONETTE
Middle Name:ANN
Last Name:IRELAND
Suffix:
Gender:F
Credentials:LSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3411
Mailing Address - Country:US
Mailing Address - Phone:207-692-7215
Mailing Address - Fax:
Practice Address - Street 1:10 RAILROAD SQ
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6133
Practice Address - Country:US
Practice Address - Phone:207-692-7215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4357171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor