Provider Demographics
NPI:1053436972
Name:LEONARDSON, NANCY WAGNER (MA AND LMHC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:WAGNER
Last Name:LEONARDSON
Suffix:
Gender:F
Credentials:MA AND LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1543
Mailing Address - Country:US
Mailing Address - Phone:360-794-1951
Mailing Address - Fax:360-794-6711
Practice Address - Street 1:125 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1543
Practice Address - Country:US
Practice Address - Phone:360-794-1951
Practice Address - Fax:360-794-6711
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health