Provider Demographics
NPI:1104439926
Name:PACAK, LEENA (LICENSED MIDWIFE)
Entity type:Individual
Prefix:
First Name:LEENA
Middle Name:
Last Name:PACAK
Suffix:
Gender:F
Credentials:LICENSED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 TEAFF ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-5711
Mailing Address - Country:US
Mailing Address - Phone:630-337-9343
Mailing Address - Fax:
Practice Address - Street 1:1803 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4238
Practice Address - Country:US
Practice Address - Phone:630-337-9343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99421176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty