MEDICARE: DR. SARAH ELIZABETH LEISENRING

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
1	2084P0800X	Psychiatry Physician	MD00039749	WA

General Provider Information

NPI Number	:	1609844836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH ELIZABETH LEISENRING

Provider Business Mailing Address
First Line	:	3857 MARTIN WAY E
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5268
Country	:	US
Telephone Number	:	360-704-7170
Fax Number	:	360-709-4374

Provider Business Practice Location Address
First Line	:	3857 MARTIN WAY E
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5268
Country	:	US
Telephone Number	:	360-704-7170
Fax Number	:	360-709-4374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/27/2019

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