Provider Demographics
NPI:1710549175
Name:JONES, LESLIE PATRICE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:PATRICE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10607 HIDDEN GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4222
Mailing Address - Country:US
Mailing Address - Phone:209-326-7713
Mailing Address - Fax:
Practice Address - Street 1:10607 HIDDEN GROVE CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4222
Practice Address - Country:US
Practice Address - Phone:209-326-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37511587106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician