Provider Demographics
NPI:1306996483
Name:LEPPANEN, PAUL (MA, EDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LEPPANEN
Suffix:
Gender:M
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1231
Mailing Address - Country:US
Mailing Address - Phone:616-842-4772
Mailing Address - Fax:616-842-5575
Practice Address - Street 1:321 FULTON ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1231
Practice Address - Country:US
Practice Address - Phone:616-842-4772
Practice Address - Fax:616-842-5575
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010653103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical