Provider Demographics
NPI:1447502257
Name:WITT, LEAH LOUISE (PSYD, LP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:LOUISE
Last Name:WITT
Suffix:
Gender:
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 2ND ST STE 120
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1920
Mailing Address - Country:US
Mailing Address - Phone:218-433-8018
Mailing Address - Fax:218-522-4432
Practice Address - Street 1:205 W 2ND ST STE 120
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1920
Practice Address - Country:US
Practice Address - Phone:218-433-8018
Practice Address - Fax:218-522-4432
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical