Provider Demographics
NPI:1326120981
Name:HENDRICKSEN, LESLIE D (HTASCP)
Entity Type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:D
Last Name:HENDRICKSEN
Suffix:
Gender:M
Credentials:HTASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S 1680 W
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5876
Mailing Address - Country:US
Mailing Address - Phone:801-221-1899
Mailing Address - Fax:801-221-1899
Practice Address - Street 1:808 S 1680 W
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5876
Practice Address - Country:US
Practice Address - Phone:801-221-1899
Practice Address - Fax:801-221-1899
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT246QH0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QH0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHistology