Provider Demographics
NPI:1821858150
Name:LEONARD, SETH (BS)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:LEONARD
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W APPLE PINE ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6058
Mailing Address - Country:US
Mailing Address - Phone:208-703-0662
Mailing Address - Fax:
Practice Address - Street 1:913 W APPLE PINE ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6058
Practice Address - Country:US
Practice Address - Phone:208-703-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker