Provider Demographics
NPI:1770041766
Name:SNOW, LESLIE LYNNE (CRAY TECH)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:LYNNE
Last Name:SNOW
Suffix:
Gender:F
Credentials:CRAY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16690 HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:MARIONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65705-7154
Mailing Address - Country:US
Mailing Address - Phone:479-244-6435
Mailing Address - Fax:
Practice Address - Street 1:325 MAINE ST LAWRENCE, KS 66044
Practice Address - Street 2:
Practice Address - City:LAWERENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-505-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology