Provider Demographics
NPI:1760282982
Name:BLONDIN, LEAH (FDN-P)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BLONDIN
Suffix:
Gender:
Credentials:FDN-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14630 E 676 RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-8126
Mailing Address - Country:US
Mailing Address - Phone:702-444-6648
Mailing Address - Fax:
Practice Address - Street 1:14630 E 676 RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-8126
Practice Address - Country:US
Practice Address - Phone:702-444-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach