Provider Demographics
NPI:1942019591
Name:LEIENDECKER, ALLIE MORGANN
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:MORGANN
Last Name:LEIENDECKER
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 1:2909 N TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2443
Mailing Address - Country:US
Mailing Address - Phone:318-202-3977
Mailing Address - Fax:
Practice Address - Street 1:2909 N TRENTON ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2443
Practice Address - Country:US
Practice Address - Phone:318-202-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician