Provider Demographics
NPI:1891088514
Name:ALLEN, LEAH (LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63485 N HIGHWAY 97 # 1012C
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-6877
Mailing Address - Country:US
Mailing Address - Phone:312-523-9234
Mailing Address - Fax:
Practice Address - Street 1:63485 N HIGHWAY 97 # 1012C
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-6877
Practice Address - Country:US
Practice Address - Phone:312-523-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL67891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical