Provider Demographics
NPI:1083750988
Name:OSBORNE, LEANNE GAIL (MA)
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:GAIL
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12374
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-0374
Mailing Address - Country:US
Mailing Address - Phone:503-252-5564
Mailing Address - Fax:
Practice Address - Street 1:521 SW 11TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2634
Practice Address - Country:US
Practice Address - Phone:503-944-1207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health