Provider Demographics
NPI:1154802411
Name:WEINS, LEAH SUE (MS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:SUE
Last Name:WEINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 S TENNIS LN
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2256
Mailing Address - Country:US
Mailing Address - Phone:605-321-1223
Mailing Address - Fax:605-362-5601
Practice Address - Street 1:4410 S TENNIS LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2256
Practice Address - Country:US
Practice Address - Phone:605-321-1223
Practice Address - Fax:605-362-5601
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLMFT20345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist