Provider Demographics
NPI:1770846529
Name:SQUIRE, LEEANN (BA, MA)
Entity Type:Individual
Prefix:MS
First Name:LEEANN
Middle Name:
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:MS
Other - First Name:LEEANN
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9990 COUNTY FARM RD STE 5
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3542
Mailing Address - Country:US
Mailing Address - Phone:951-358-4834
Mailing Address - Fax:
Practice Address - Street 1:9990 COUNTY FARM RD STE 5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3542
Practice Address - Country:US
Practice Address - Phone:951-358-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker