Healthcare Provider Details

I. General information

NPI: 1205913555
Provider Name (Legal Business Name): LESLIE ANN CAMPBELL LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S EUNICE ST
PORT ANGELES WA
98362-7904
US

IV. Provider business mailing address

2713 DAN KELLY RD
PORT ANGELES WA
98363-9695
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-0333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00018226
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: