Provider Demographics
NPI:1629346150
Name:CROSSAN, LESLIE A (MA, MS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:CROSSAN
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9046 NE 195TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:425-312-2636
Mailing Address - Fax:
Practice Address - Street 1:9046 NE 195TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2233
Practice Address - Country:US
Practice Address - Phone:425-312-2636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60259143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist