Provider Demographics
NPI:1790965671
Name:BOWER, LESLIE ANN (LMP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:BOWER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 1/2 N 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6122
Mailing Address - Country:US
Mailing Address - Phone:208-921-1435
Mailing Address - Fax:
Practice Address - Street 1:1830 1/2 N 54TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6122
Practice Address - Country:US
Practice Address - Phone:208-921-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist