Provider Demographics
NPI:1558488551
Name:BROWN, LESLIE ALLISON (LMT, BA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ALLISON
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 HAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2512
Mailing Address - Country:US
Mailing Address - Phone:360-734-9139
Mailing Address - Fax:360-752-1644
Practice Address - Street 1:1050 LARRABEE AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7367
Practice Address - Country:US
Practice Address - Phone:360-671-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA024201MA00003688225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist