Provider Demographics
NPI:1851573463
Name:LEITNER, WANDA J
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:J
Last Name:LEITNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2461
Mailing Address - Country:US
Mailing Address - Phone:262-548-7987
Mailing Address - Fax:
Practice Address - Street 1:1501 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2461
Practice Address - Country:US
Practice Address - Phone:262-548-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor