Provider Demographics
NPI:1598838146
Name:CARPENTER, LESLIE A (MGC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:MGC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-8130
Practice Address - Fax:206-598-2359
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU28811OtherREGENCE BLUESHIELD