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General NPI Number Information
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NPI Number | 1962598599
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Entity Type | Individual
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Provider Name | LESLIE RISIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 731 E MAIN ST UNIT 13
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City | JACKSON
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State | OH
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Zip | 45640-2100
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Country | US
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Telephone | 740-286-8789
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Fax | 740-286-8789
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Provider Business Mailing Address
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Address Line | 731 E MAIN ST UNIT 13
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City | JACKSON
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State | OH
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Zip | 45640-2100
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Country | US
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Telephone | 740-286-8789
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Fax | 740-286-8789
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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 | 4453
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License Number State | OH
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