Provider Demographics
NPI:1598595571
Name:BURKHART, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BURKHART
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 1:1655 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4347
Mailing Address - Country:US
Mailing Address - Phone:503-339-7689
Mailing Address - Fax:503-339-7557
Practice Address - Street 1:1655 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4347
Practice Address - Country:US
Practice Address - Phone:503-339-7689
Practice Address - Fax:503-339-7557
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-3120873171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach