Provider Demographics
NPI:1619021946
Name:CHEGWIDDEN, LESLIE J (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:CHEGWIDDEN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 S. RIMPAU
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879
Mailing Address - Country:US
Mailing Address - Phone:951-736-0727
Mailing Address - Fax:
Practice Address - Street 1:1451 S. RIMPAU
Practice Address - Street 2:SUITE 207
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-736-0727
Practice Address - Fax:951-736-0220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT28711OtherMARRIAGE FAMILY LICENSE