Provider Demographics
NPI:1790088276
Name:LEAHY, RACHEL MARIE (MA, LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:LEAHY
Suffix:
Gender:F
Credentials:MA, LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 N ARDMORE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1805
Mailing Address - Country:US
Mailing Address - Phone:920-912-0067
Mailing Address - Fax:
Practice Address - Street 1:600 W VIRGINIA ST
Practice Address - Street 2:STE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1500
Practice Address - Country:US
Practice Address - Phone:414-831-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14152-130101YA0400X
WI4401-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)