Provider Demographics
NPI:1164606695
Name:JANTSCH WADDELL, LESLIE GENE (MA LPC NCP CCDP DIPL)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:GENE
Last Name:JANTSCH WADDELL
Suffix:
Gender:F
Credentials:MA LPC NCP CCDP DIPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005-1925
Mailing Address - Country:US
Mailing Address - Phone:724-869-2030
Mailing Address - Fax:
Practice Address - Street 1:227 WAYNE ST
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1925
Practice Address - Country:US
Practice Address - Phone:724-869-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional