Healthcare Provider Details

I. General information

NPI: 1346395183
Provider Name (Legal Business Name): LESLIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 N BURK ST
GILBERT AZ
85234-3476
US

IV. Provider business mailing address

8630 E NATAL AVE
MESA AZ
85209-6786
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-3816
  • Fax:
Mailing address:
  • Phone: 480-926-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number103TM1700X
License Number StateAZ

VIII. Authorized Official

Name: MRS. LESLIE ANN HUISH
Title or Position: SCHOOL PSYCHOLOGIST
Credential:
Phone: 480-926-3816