Provider Demographics
NPI:1306091467
Name:LEGGIO, JOHN W (MA LISAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:LEGGIO
Suffix:
Gender:M
Credentials:MA LISAC
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:W
Other - Last Name:LEGGIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LISAC
Mailing Address - Street 1:4653 E PIMA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3437
Mailing Address - Country:US
Mailing Address - Phone:520-326-6182
Mailing Address - Fax:520-326-9034
Practice Address - Street 1:4653 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3437
Practice Address - Country:US
Practice Address - Phone:520-326-6182
Practice Address - Fax:520-326-9034
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1054101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor