MEDICARE: LESLIE NICOLE CLEMENTS LCSW

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	1041C0700X	Clinical Social Worker	L17543	OR
2	1041C0700X	Clinical Social Worker	L6043	OR

General Provider Information

NPI Number	:	1679994610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE NICOLE CLEMENTS LCSW

Provider Business Mailing Address
First Line	:	11211 SE SUNNYSIDE RD
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-7787
Country	:	US
Telephone Number	:	503-740-1971
Fax Number	:	503-781-2436

Provider Business Practice Location Address
First Line	:	11211 SE SUNNYSIDE RD
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-7787
Country	:	US
Telephone Number	:	503-740-1971
Fax Number	:	503-781-2436

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

Provider Enumeration Date	:	12/18/2013
Last Update Date	:	01/20/2026

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