1861710899 NPI number — LEIGH ANNE CHESTER BCBA

Table of content: LEIGH ANNE CHESTER BCBA (NPI 1861710899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861710899 NPI number — LEIGH ANNE CHESTER BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHESTER
Provider First Name:
LEIGH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLEATON
Provider Other First Name:
LEIGH
Provider Other Middle Name:
HUTCHINS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861710899
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11454 127TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33778-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-742-7872
Provider Business Mailing Address Fax Number:
877-271-9338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7669 BARRY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEMINOLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33772-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-742-7872
Provider Business Practice Location Address Fax Number:
877-271-9338
Provider Enumeration Date:
05/14/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-13-12719 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009628000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017472400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".