Provider Demographics
NPI:1063295673
Name:DUCKWORTH, LEAH J (RRT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:J
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 STATE HIGHWAY 214
Mailing Address - Street 2:
Mailing Address - City:CARPENTER
Mailing Address - State:WY
Mailing Address - Zip Code:82054-9664
Mailing Address - Country:US
Mailing Address - Phone:307-274-1884
Mailing Address - Fax:
Practice Address - Street 1:2360 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5356
Practice Address - Country:US
Practice Address - Phone:307-778-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY16022278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral CareGroup - Single Specialty