Provider Demographics
NPI:1710954953
Name:LEGAN, LEONE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEONE
Middle Name:
Last Name:LEGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 N KNOXVILLE
Mailing Address - Street 2:PSYCHOLOGICAL ASSOCIATES
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:309-691-0420
Mailing Address - Fax:309-691-0520
Practice Address - Street 1:5409 N KNOXVILLE AVE
Practice Address - Street 2:PSYCHOLOGICAL ASSOCIATES
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614
Practice Address - Country:US
Practice Address - Phone:309-691-0420
Practice Address - Fax:309-691-0520
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
07220997OtherBLUE CROSS BLUE SHIELD
209355Medicare ID - Type Unspecified