Provider Demographics
NPI:1982251591
Name:LENARD, ALESHA
Entity Type:Individual
Prefix:
First Name:ALESHA
Middle Name:
Last Name:LENARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 S JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-7764
Mailing Address - Country:US
Mailing Address - Phone:918-577-0682
Mailing Address - Fax:
Practice Address - Street 1:901 S. HARRILL AVE
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467
Practice Address - Country:US
Practice Address - Phone:918-577-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician