Individual
SHANNON T LEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BA CMS
Contact information
Practice address
4835 POPLAR LEVEL RD STE 110, LOUISVILLE, KY 40213-2906
(502) 443-5273
(502) 631-9660
Mailing address
11110 LITTLE SPRING BLVD, LOUISVILLE, KY 40291-5066
(502) 712-8905
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/31/2018
Last updated
12/31/2018
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