Provider Demographics
NPI:1912261215
Name:LEEPER, RACHEL DAWN (MA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DAWN
Last Name:LEEPER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394A 19TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6377
Mailing Address - Country:US
Mailing Address - Phone:412-760-1451
Mailing Address - Fax:
Practice Address - Street 1:394A 19TH ST
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6377
Practice Address - Country:US
Practice Address - Phone:412-760-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist