Provider Demographics
NPI:1639304629
Name:BENTLEY, LEAH MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MARIE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4377 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9305
Mailing Address - Country:US
Mailing Address - Phone:319-930-1409
Mailing Address - Fax:
Practice Address - Street 1:2533 SCOTT BLVD SE
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-8195
Practice Address - Country:US
Practice Address - Phone:319-388-9212
Practice Address - Fax:319-341-9443
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker