Provider Demographics
NPI:1912596917
Name:LEUTZINGER, PATRICK
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:LEUTZINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:LEUTZINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:65 CHERYL LN APT B
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1346
Mailing Address - Country:US
Mailing Address - Phone:636-224-8439
Mailing Address - Fax:
Practice Address - Street 1:1221 CEDAR VALLEY DR APT E
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1282
Practice Address - Country:US
Practice Address - Phone:636-208-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172A00000XOther Service ProvidersDriver
No174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No253Z00000XAgenciesIn Home Supportive Care