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NPI Code Detail

MEDICARE: LESLIE EBAUGH-NOORDHOEK BCBA

MEDICARE: LESLIE EBAUGH-NOORDHOEK BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-24-76598NV

General Provider Information

NPI Number : 1508510728
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE EBAUGH-NOORDHOEK BCBA
Provider Business Mailing Address
First Line : 1060 WIGWAM PKWY
Second Line :
City : HENDERSON
State : NV
Zip : 89074-8162
Country : US
Telephone Number : 702-547-6971
Fax Number : 702-547-6948
Provider Business Practice Location Address
First Line : 3950 LAS VEGAS BLVD N
Second Line :
City : LAS VEGAS
State : NV
Zip : 89115-0598
Country : US
Telephone Number : 702-547-6971
Fax Number : 702-547-6948
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2022
Last Update Date : 10/16/2024

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Directions to “ LESLIE EBAUGH-NOORDHOEK BCBA” Practice Location

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