Provider Demographics
NPI:1679963664
Name:YAZZIE, LEONARDA SUE
Entity Type:Individual
Prefix:MRS
First Name:LEONARDA
Middle Name:SUE
Last Name:YAZZIE
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 1:4100 BARBARA LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1000
Mailing Address - Country:US
Mailing Address - Phone:502-570-2854
Mailing Address - Fax:866-882-3750
Practice Address - Street 1:4100 BARBARA LOOP SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1000
Practice Address - Country:US
Practice Address - Phone:502-570-2854
Practice Address - Fax:866-882-3750
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst