Individual
DR. JONATHAN L. LEGGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
303 S FIRST ST, GALLUP, NM 87301-6211
(505) 397-7197
Mailing address
303 S FIRST ST, GALLUP, NM 87301-6211
(505) 397-7197
(855) 340-4551
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
99045855A
IN
103TC1900X
Counseling Psychologist
1279
NM
103TP0016X
Prescribing (Medical) Psychologist
Primary
1279
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201050210
—
IN
Enumeration date
03/02/2011
Last updated
06/27/2023
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