Healthcare Provider Details

I. General information

NPI: 1346260932
Provider Name (Legal Business Name): LAURA A EDWARDS-LEEPER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 NW GREENBRIER PKWY STE 240
BEAVERTON OR
97006-7374
US

IV. Provider business mailing address

15455 NW GREENBRIER PKWY STE 240
BEAVERTON OR
97006-7374
US

V. Phone/Fax

Practice location:
  • Phone: 503-713-5323
  • Fax: 503-617-0475
Mailing address:
  • Phone: 503-713-5323
  • Fax: 503-617-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8599
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2260
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY60221263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: