Provider Demographics
NPI:1992274237
Name:LEGGETT, KIAN (LICSW, SMMHS)
Entity type:Individual
Prefix:
First Name:KIAN
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:LICSW, SMMHS
Other - Prefix:
Other - First Name:KEANNE
Other - Middle Name:
Other - Last Name:LEGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:270 MOX CHEHALIS RD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-9237
Mailing Address - Country:US
Mailing Address - Phone:253-299-4664
Mailing Address - Fax:253-993-4566
Practice Address - Street 1:270 MOX CHEHALIS RD
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9237
Practice Address - Country:US
Practice Address - Phone:253-299-4664
Practice Address - Fax:253-993-4566
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC606975761041C0700X
WALW609964011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical