Provider Demographics
NPI:1891423869
Name:AMBOISE, LEAH K (APSW)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:K
Last Name:AMBOISE
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N MCCARTHY RD STE P
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-9112
Mailing Address - Country:US
Mailing Address - Phone:920-903-1060
Mailing Address - Fax:920-903-1164
Practice Address - Street 1:119 N MCCARTHY RD STE P
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-9112
Practice Address - Country:US
Practice Address - Phone:920-903-1060
Practice Address - Fax:920-903-1164
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132858-1211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical