Provider Demographics
NPI:1598374852
Name:STADEL, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:STADEL
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 1:4469 RAINBOW LN
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-6228
Mailing Address - Country:US
Mailing Address - Phone:810-443-3104
Mailing Address - Fax:
Practice Address - Street 1:10683 S SAGINAW ST STE B
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8127
Practice Address - Country:US
Practice Address - Phone:810-771-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical