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NPI Code Detail

MEDICARE: DR. ANDIE MAIKA LESLIE PH.D.

MEDICARE: DR. ANDIE MAIKA LESLIE PH.D.
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
1103TC0700XClinical PsychologistPSB94027727CA

General Provider Information

NPI Number : 1568984664
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDIE MAIKA LESLIE PH.D.
Provider Business Mailing Address
First Line : PO BOX 2077
Second Line :
City : UKIAH
State : CA
Zip : 95482-2077
Country : US
Telephone Number : 707-467-2010
Fax Number :
Provider Business Practice Location Address
First Line : 516 CYPRESS ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-5410
Country : US
Telephone Number : 707-961-0308
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2017
Last Update Date : 07/16/2024

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