Provider Demographics
NPI:1477576387
Name:THOMSON, LESLIE ANN L (RD, MS)
Entity Type:Individual
Prefix:
First Name:LESLIE ANN
Middle Name:L
Last Name:THOMSON
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:LESLIE ANN
Other - Middle Name:L
Other - Last Name:LOBEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:M/S 359107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-8920
Mailing Address - Fax:206-598-7663
Practice Address - Street 1:4225 ROOSEVELT WAY
Practice Address - Street 2:BOX 356176
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4882
Practice Address - Fax:206-598-4976
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001009133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0163309OtherLABOR & INDUSTRY
WA8344533Medicaid
P77446Medicare UPIN
WAAB34058Medicare PIN