Provider Demographics
NPI:1508519919
Name:REYNOLDS, LEANNA H (MSW, APSW)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:H
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:H
Other - Last Name:HAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-0301
Mailing Address - Country:US
Mailing Address - Phone:608-742-5518
Mailing Address - Fax:608-742-4087
Practice Address - Street 1:2702 INTERNATIONAL LN STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3117
Practice Address - Country:US
Practice Address - Phone:608-405-5712
Practice Address - Fax:608-405-5716
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132127104100000X
WI11386-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker