Provider Demographics
NPI:1053927103
Name:LEEK, ALLASON P
Entity type:Individual
Prefix:
First Name:ALLASON
Middle Name:P
Last Name:LEEK
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 1:34 ERLANGER RD
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1728
Mailing Address - Country:US
Mailing Address - Phone:859-341-5782
Mailing Address - Fax:859-341-5783
Practice Address - Street 1:34 ERLANGER RD
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1728
Practice Address - Country:US
Practice Address - Phone:859-341-5782
Practice Address - Fax:859-341-5783
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-20-135838106S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician