Provider Demographics
NPI:1831636240
Name:LEECH, HALLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HALLE
Middle Name:
Last Name:LEECH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4922 STATE ROUTE 95
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-9151
Mailing Address - Country:US
Mailing Address - Phone:419-631-9471
Mailing Address - Fax:
Practice Address - Street 1:4922 STATE ROUTE 95
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-9151
Practice Address - Country:US
Practice Address - Phone:419-631-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN157351164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse