MEDICARE: DR. LESLIE MARSHALL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	SS1658	FL

General Provider Information

NPI Number	:	1053176438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE MARSHALL PHD

Provider Business Mailing Address
First Line	:	1465 S FORT HARRISON AVE STE 204
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2504
Country	:	US
Telephone Number	:	727-746-5812
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 S FORT HARRISON AVE STE 204
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2504
Country	:	US
Telephone Number	:	727-746-5812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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Directions to “ DR. LESLIE MARSHALL PHD” Practice Location

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