Provider Demographics
NPI:1457816076
Name:LEISHMAN, NATHAN (RBT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:LEISHMAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 W 1700 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4182
Mailing Address - Country:US
Mailing Address - Phone:435-565-7265
Mailing Address - Fax:
Practice Address - Street 1:358 S 700 E STE B307
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-2161
Practice Address - Country:US
Practice Address - Phone:435-565-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician