Provider Demographics
NPI:1124184205
Name:COHN, LESLIE G (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:G
Last Name:COHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 MINOR AVE
Mailing Address - Street 2:DEARBORN CARRIAGE HOUSE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-4246
Mailing Address - Country:US
Mailing Address - Phone:206-979-3172
Mailing Address - Fax:206-386-2202
Practice Address - Street 1:1117 MINOR AVE
Practice Address - Street 2:DEARBORN CARRIAGE HOUSE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-4246
Practice Address - Country:US
Practice Address - Phone:206-979-3172
Practice Address - Fax:206-386-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPS00002701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ46772Medicare UPIN