Provider Demographics
NPI:1326310145
Name:LESLIE, KATHERINE E (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4107
Mailing Address - Country:US
Mailing Address - Phone:919-960-1623
Mailing Address - Fax:720-598-9383
Practice Address - Street 1:4430 ARAPAHOE AVE STE 215
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1100
Practice Address - Country:US
Practice Address - Phone:919-960-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076211041C0700X
COCSW.099242281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical