Provider Demographics
NPI:1689421505
Name:EDGINGTON, LETA KAY
Entity type:Individual
Prefix:
First Name:LETA
Middle Name:KAY
Last Name:EDGINGTON
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 1:554 PRATER WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4536
Mailing Address - Country:US
Mailing Address - Phone:775-350-2358
Mailing Address - Fax:
Practice Address - Street 1:131 RYLAND ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2214
Practice Address - Country:US
Practice Address - Phone:775-350-2358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10096-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker