Most Relevant Information
Provider Data
| NPI Number: | 1003668245 |
| Provider Name: | ROBERT LEACH |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/02/2024 |
| Last Updated: | 04/02/2024 |
Provider Practice Location
614 N 6TH ST
SPRINGFIELD
IL
627025313
Practice Location Phone/Fax
| Phone: | 5743874313 |
| Fax: |
Provider Mailing Location
215 RED COACH DR
MISHAWAKA
IN
465458307
Provider Mailing Phone/Fax
| Phone: | 5742040116 |
| Fax: |