Doctor Name: | SAMANTHA AMBER LEIBFRIED |
NPI Number: | 1104168186 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PC-IT |
License Number: | 1689-226 |
Business Practice Address: | 1155 N Elm St # 120 Platteville, WI - 538181207 |
Business Phone Number: | 6083484060 |
Business Fax Number: | 6083484191 |
Mailing Address: | 1155 N Elm St # 120, PLATTEVILLE |
State: | WI |
Postal Code: | 538181207 |
Phone Number: | 6083484060 |
Fax Number: | 6083484191 |
NPI Enumeration Date: | 03/18/2013 |
NPI Last Update Date: | 03/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1689-226 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |