Provider Demographics
NPI:1053826735
Name:MCFADDEN, LESLIE E
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3310
Mailing Address - Country:US
Mailing Address - Phone:702-490-9009
Mailing Address - Fax:866-737-6147
Practice Address - Street 1:3235 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3310
Practice Address - Country:US
Practice Address - Phone:702-490-9009
Practice Address - Fax:866-737-6147
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician