Provider Demographics
NPI:1508214255
Name:BICKFORD, LEANN
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:BICKFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 HAMILTON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:237 HAMILTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2983
Practice Address - Country:US
Practice Address - Phone:860-587-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program