Provider Demographics
NPI:1215023742
Name:SCHNEIDER, LESLIE PAUL (PHD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:PAUL
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98903
Mailing Address - Country:US
Mailing Address - Phone:509-966-7131
Mailing Address - Fax:509-972-3907
Practice Address - Street 1:307 S 12TH AVE STE 21
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-972-3905
Practice Address - Fax:509-972-3907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911458963Medicare UPIN
WA119580Medicare ID - Type Unspecified