Provider Information for 1912447004
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KENDRA DEANNE DAVIS-LEIGHTY LCSW
Other Names:Professional Name:KENDRA DEANNE DAVIS- LEIGHTY LCSWSex: Female
NPI: 1912447004
Last Updated: 2019-07-31
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1912447004 | ||||||||
| Enumeration Date | 2017-03-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1535 NE RICE RD LEES SUMMIT, MO 64086-5849 United States Phone: 816-965-1612 | Fax:816-347-3209 | ||||||||
| Primary Practice Address | 1535 NE RICE RD LEES SUMMIT, MO 64086-5849 United States Phone: 816-965-1612 | Fax: | ||||||||
| Secondary Practice Address(es) | 2659 PEERY AVE | ||||||||
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