Provider Demographics
NPI:1194087635
Name:ROLFE, LEITA ASHLEY
Entity type:Individual
Prefix:
First Name:LEITA
Middle Name:ASHLEY
Last Name:ROLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2443
Mailing Address - Country:US
Mailing Address - Phone:307-941-1774
Mailing Address - Fax:
Practice Address - Street 1:622 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2443
Practice Address - Country:US
Practice Address - Phone:307-941-1774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator