Provider Demographics
NPI:1639453236
Name:ULSTED, LEAH MICHELLE (ND)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MICHELLE
Last Name:ULSTED
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3083
Mailing Address - Country:US
Mailing Address - Phone:503-487-6018
Mailing Address - Fax:
Practice Address - Street 1:200 E 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3083
Practice Address - Country:US
Practice Address - Phone:503-487-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-01
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1845175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath