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General NPI Number Information
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NPI Number | 1548774714
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Entity Type | Individual
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Provider Name | MICHELLE JILL LEGER PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 1370 BREA BLVD STE 210
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City | FULLERTON
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State | CA
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Zip | 92835-4128
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Country | US
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Telephone | 714-900-3907
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Fax |
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Provider Business Mailing Address
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Address Line | 135 E HOLLY ST APT 304
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City | PASADENA
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State | CA
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Zip | 91103-3942
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Country | US
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Telephone | 714-980-2332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31621
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License Number State | CA
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