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NPI Code Detail

MEDICARE: DR. LESLIE SMITH PHD

MEDICARE: DR. LESLIE SMITH 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
1103TC0700XClinical PsychologistTY00003342WA

General Provider Information

NPI Number : 1164480638
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LESLIE SMITH PHD
Provider Business Mailing Address
First Line : 9340 NE 76TH ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-3721
Country : US
Telephone Number : 360-253-4912
Fax Number : 360-253-5170
Provider Business Practice Location Address
First Line : 5220 NE HAZEL DELL AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-1242
Country : US
Telephone Number : 360-693-1474
Fax Number : 360-694-7470
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/08/2007

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Directions to “ DR. LESLIE SMITH PHD” Practice Location

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