Provider Demographics
NPI:1710182027
Name:LEGLEITNER, CORWIN (LLP)
Entity type:Individual
Prefix:MR
First Name:CORWIN
Middle Name:
Last Name:LEGLEITNER
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6449 E. GRAND LAKE RD.
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:MI
Mailing Address - Zip Code:49777-1154
Mailing Address - Country:US
Mailing Address - Phone:810-238-5958
Mailing Address - Fax:
Practice Address - Street 1:420 W. FIFTH AVE.
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-1154
Practice Address - Country:US
Practice Address - Phone:810-238-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional