Provider Demographics
NPI:1821036344
Name:LEI, LINNEA SUZANNE (EDD)
Entity Type:Individual
Prefix:DR
First Name:LINNEA
Middle Name:SUZANNE
Last Name:LEI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W RIORDAN RD
Mailing Address - Street 2:SUITE 100, #326
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:416 N KENDRICK ST
Practice Address - Street 2:SUITE 4
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1598
Practice Address - Country:US
Practice Address - Phone:928-774-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3020103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0606240OtherPSYCHOLOGIST
AZZEDD3020Medicare PIN