Provider Demographics
NPI:1891345534
Name:NORDSTROM, LEIGHANNA MARIE (BS, NLC)
Entity Type:Individual
Prefix:
First Name:LEIGHANNA
Middle Name:MARIE
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:BS, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 61ST AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3049
Mailing Address - Country:US
Mailing Address - Phone:970-281-4667
Mailing Address - Fax:
Practice Address - Street 1:1711 61ST AVE STE 206
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3049
Practice Address - Country:US
Practice Address - Phone:970-281-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-15
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist