Provider Demographics
NPI:1861512360
Name:LEGAY, KATHY H
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:H
Last Name:LEGAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 BITTERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4003
Mailing Address - Country:US
Mailing Address - Phone:636-256-7501
Mailing Address - Fax:636-386-0193
Practice Address - Street 1:509 BITTERFIELD DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4003
Practice Address - Country:US
Practice Address - Phone:636-256-7501
Practice Address - Fax:636-386-0193
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
MO320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities