Provider Demographics
NPI:1497038731
Name:STEWART, LEANDRA JONICOLE (PHD)
Entity type:Individual
Prefix:
First Name:LEANDRA
Middle Name:JONICOLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LEANDRA
Other - Middle Name:JONICOLE
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:126 SW 148TH ST
Mailing Address - Street 2:STE C100-BOX #565
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1984
Mailing Address - Country:US
Mailing Address - Phone:206-495-2888
Mailing Address - Fax:
Practice Address - Street 1:10011 21ST AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-3704
Practice Address - Country:US
Practice Address - Phone:206-495-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60649774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical