Healthcare Provider Details

I. General information

NPI: 1891601936
Provider Name (Legal Business Name): LESLIE MCCALLISTER CADC1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 NW 4TH ST
CORVALLIS OR
97330-6409
US

IV. Provider business mailing address

426 NW 4TH ST
CORVALLIS OR
97330-6409
US

V. Phone/Fax

Practice location:
  • Phone: 541-286-4439
  • Fax:
Mailing address:
  • Phone: 541-286-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-5537
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: