Provider Demographics
NPI:1093961476
Name:SLEASMAN, JUSTIN ROY (CCP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ROY
Last Name:SLEASMAN
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13824 N CREEK DR
Mailing Address - Street 2:901
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-2068
Mailing Address - Country:US
Mailing Address - Phone:425-293-4758
Mailing Address - Fax:650-615-9995
Practice Address - Street 1:13824 N CREEK DR
Practice Address - Street 2:901
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-2068
Practice Address - Country:US
Practice Address - Phone:425-293-4758
Practice Address - Fax:650-615-9995
Is Sole Proprietor?:No
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA059091242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist