Provider Demographics
NPI:1578768537
Name:YOUNG, LESLIE H (MS)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:H
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 W BURNSIDE ST STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3727
Mailing Address - Country:US
Mailing Address - Phone:971-407-4100
Mailing Address - Fax:971-407-4103
Practice Address - Street 1:2230 W BURNSIDE ST STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3727
Practice Address - Country:US
Practice Address - Phone:971-407-4100
Practice Address - Fax:971-407-4103
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51485231H00000X
OR30786231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80375AOtherBCBS
TX175441801Medicaid
TX175441801Medicaid