Provider Demographics
NPI:1417615014
Name:ROCHA-DUNN, LESLIE D
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:ROCHA-DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:D
Other - Last Name:ROCHA-ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2203 OLD HIGHWAY 99 S RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-9009
Practice Address - Country:US
Practice Address - Phone:360-542-8810
Practice Address - Fax:360-542-8811
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61276498101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor