Provider Demographics
NPI:1578185245
Name:BLANSON, LEIGHANNA S
Entity Type:Individual
Prefix:
First Name:LEIGHANNA
Middle Name:S
Last Name:BLANSON
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 1:107 LIBBY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-5532
Mailing Address - Country:US
Mailing Address - Phone:318-732-1185
Mailing Address - Fax:
Practice Address - Street 1:201 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2067
Practice Address - Country:US
Practice Address - Phone:318-600-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator