Provider Demographics
NPI:1730456187
Name:LELAND, ERNEST JAMES (LMP)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:JAMES
Last Name:LELAND
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 NE VANCOUVER MALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-8206
Mailing Address - Country:US
Mailing Address - Phone:360-567-0488
Mailing Address - Fax:360-567-0489
Practice Address - Street 1:9300 NE VANCOUVER MALL DR STE 201
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-8206
Practice Address - Country:US
Practice Address - Phone:360-567-0488
Practice Address - Fax:360-567-0489
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60256018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist