Provider Demographics
NPI:1942452784
Name:LEONARD, LINDA MADREE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MADREE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:MADREE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1869 E SELTICE WAY # 107
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7019
Mailing Address - Country:US
Mailing Address - Phone:208-625-8617
Mailing Address - Fax:
Practice Address - Street 1:1224 N IDAHO ST STE 3
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8615
Practice Address - Country:US
Practice Address - Phone:208-625-8617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133709761041C0700X
WALW611843921041C0700X
IDLCSW-291011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807335700Medicaid
ID807652000Medicaid
ID807342300Medicaid