Provider Demographics
NPI:1710198361
Name:LEEP, SARAH J (CN)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:J
Last Name:LEEP
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2219
Mailing Address - Country:US
Mailing Address - Phone:219-922-3663
Mailing Address - Fax:219-922-3939
Practice Address - Street 1:128 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2219
Practice Address - Country:US
Practice Address - Phone:219-922-3663
Practice Address - Fax:219-922-3939
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000328133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist