Provider Demographics
NPI:1063159788
Name:LEECK, DEBORAH (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LEECK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 WOODED RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:FOGELSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18051-1948
Mailing Address - Country:US
Mailing Address - Phone:215-518-8667
Mailing Address - Fax:
Practice Address - Street 1:2060 WOODED RIDGE CIR
Practice Address - Street 2:
Practice Address - City:FOGELSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18051-1948
Practice Address - Country:US
Practice Address - Phone:215-518-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-14
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN631467163WL0100X
PAL-301093163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant