Provider Demographics
NPI:1427883933
Name:LEACH, WINDOLYN SHADAE
Entity type:Individual
Prefix:
First Name:WINDOLYN
Middle Name:SHADAE
Last Name:LEACH
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 1:1522 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-2007
Mailing Address - Country:US
Mailing Address - Phone:409-289-0685
Mailing Address - Fax:
Practice Address - Street 1:1522 ADAMS RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-2007
Practice Address - Country:US
Practice Address - Phone:409-289-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker