Provider Demographics
NPI:1265626220
Name:IANNUCCI, LEA ANN
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:ANN
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:ANN
Other - Last Name:IANNUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BACHELOR
Mailing Address - Street 1:10401 HOLLYHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7516
Mailing Address - Country:US
Mailing Address - Phone:405-577-2804
Mailing Address - Fax:
Practice Address - Street 1:10401 HOLLYHEAD WAY
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7516
Practice Address - Country:US
Practice Address - Phone:405-577-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health