Provider Demographics
NPI:1700408150
Name:BOONE, LEAH D
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:D
Last Name:BOONE
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 1:34173 BOND DR
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-9515
Mailing Address - Country:US
Mailing Address - Phone:260-615-6372
Mailing Address - Fax:
Practice Address - Street 1:34173 BOND DR
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-9515
Practice Address - Country:US
Practice Address - Phone:260-615-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician