Provider Demographics
NPI:1821478660
Name:COOLEY, LESLIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 FOREST AVE
Mailing Address - Street 2:C
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3367
Mailing Address - Country:US
Mailing Address - Phone:831-298-0631
Mailing Address - Fax:
Practice Address - Street 1:311 FOREST AVE
Practice Address - Street 2:C
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-3367
Practice Address - Country:US
Practice Address - Phone:831-298-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist