Provider Demographics
NPI:1659522555
Name:LEO, ART C (BSW, CSAC)
Entity Type:Individual
Prefix:
First Name:ART
Middle Name:C
Last Name:LEO
Suffix:
Gender:M
Credentials:BSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1654 WASHINGTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-2047
Mailing Address - Country:US
Mailing Address - Phone:262-633-5001
Mailing Address - Fax:262-633-2928
Practice Address - Street 1:1654 WASHINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2047
Practice Address - Country:US
Practice Address - Phone:262-633-5001
Practice Address - Fax:262-633-2928
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39389900Medicaid