Provider Demographics
NPI:1578883070
Name:LEGLEITER, KELLI D (LSCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:D
Last Name:LEGLEITER
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3123
Mailing Address - Country:US
Mailing Address - Phone:620-792-2544
Mailing Address - Fax:620-792-4323
Practice Address - Street 1:5815 BROADWAY
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3123
Practice Address - Country:US
Practice Address - Phone:620-792-2544
Practice Address - Fax:620-792-2544
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 23851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200654610AMedicaid