Individual
JOHN NICHOLSON LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 424-6119
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 424-6119
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
IL
Other
Enumeration date
08/11/2006
Last updated
07/08/2007
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