Provider Demographics
NPI:1700542313
Name:LEITH, ALISHA I (CRM)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:I
Last Name:LEITH
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:I
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-2744
Mailing Address - Country:US
Mailing Address - Phone:541-350-9366
Mailing Address - Fax:
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2744
Practice Address - Country:US
Practice Address - Phone:541-350-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-CRM-695175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR21-CRM-695OtherCRM LICENSURE