Provider Demographics
NPI:1578328936
Name:HAGGARD, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HAGGARD
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 1:727 CASS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5209
Mailing Address - Country:US
Mailing Address - Phone:832-217-7230
Mailing Address - Fax:616-221-0791
Practice Address - Street 1:727 CASS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5209
Practice Address - Country:US
Practice Address - Phone:832-217-7230
Practice Address - Fax:616-221-0791
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education