Organization
EDA LEACH
Active
Organization
EDA LEACH
Active
Other names
Eda Leach
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EDA MONICA LEACH LMSW (SOCIAL WORKER)
(616) 531-1142
Entity
Organization
Contact information
Practice address
1746 DEN HERTOG ST SW, WYOMING, MI 49519-3337
(616) 531-1142
(616) 531-1142
Mailing address
1746 DEN HERTOG ST SW, WYOMING, MI 49519-3337
(616) 531-1142
(616) 531-1142
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
638107811
MI
302F00000X
Exclusive Provider Organization
Primary
638107811
MI
305S00000X
Point of Service
638107811
MI
Other
Enumeration date
04/29/2010
Last updated
04/29/2010
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