Provider Demographics
NPI:1548774714
Name:LEGER, MICHELLE JILL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:JILL
Last Name:LEGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E HOLLY ST APT 304
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3942
Mailing Address - Country:US
Mailing Address - Phone:714-980-2332
Mailing Address - Fax:
Practice Address - Street 1:1370 BREA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4128
Practice Address - Country:US
Practice Address - Phone:714-900-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical