Provider Demographics
NPI:1538875778
Name:WILLIAMS, LESLIE (PSS, IPS, CHW, QMHA-)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PSS, IPS, CHW, QMHA-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2584 NW KINGWOOD AVE # C103
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6603
Mailing Address - Country:US
Mailing Address - Phone:541-550-0253
Mailing Address - Fax:
Practice Address - Street 1:2584 NW KINGWOOD AVE # C103
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6603
Practice Address - Country:US
Practice Address - Phone:541-550-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105992175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist