Provider Demographics
NPI:1528244415
Name:LEACH, AMANDA B (RD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:LEACH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:360 ROUTE 101
Mailing Address - Street 2:UNIT 10
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5030
Mailing Address - Country:US
Mailing Address - Phone:603-472-2846
Mailing Address - Fax:603-472-2872
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-610-8095
Practice Address - Fax:603-610-8096
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH453133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered