Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 129937 | KY |
NPI | 1053903484 |
---|---|
Provider Name | Mackenzie Leachman |
First Address | Lexington, KY 40504-3274 |
Second Address | Lexington, KY 40504-3274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2021 |
Last Update Date | 08/02/2021 |