Individual
LAURA LEAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-1198
Mailing address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-1198
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/28/2021
Last updated
02/21/2025
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