Provider Demographics
NPI:1982702882
Name:LEININGER, BRUCE EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:LEININGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WEST SECOND STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-473-7925
Mailing Address - Fax:307-473-7925
Practice Address - Street 1:111 WEST SECOND STREET
Practice Address - Street 2:SUITE 310
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-473-7925
Practice Address - Fax:307-473-7925
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY258103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110079302Medicaid
WY110079302Medicaid
WY303624Medicare ID - Type Unspecified