Provider Demographics
NPI:1346637675
Name:BOW, LESLIE ELLEN
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELLEN
Last Name:BOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 RACHEL CT
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4989
Mailing Address - Country:US
Mailing Address - Phone:916-899-9420
Mailing Address - Fax:
Practice Address - Street 1:2602 RACHEL CT
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4989
Practice Address - Country:US
Practice Address - Phone:916-899-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator