Provider Demographics
NPI:1831145556
Name:PITCHFORD, LESLIE JANELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JANELLE
Last Name:PITCHFORD
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 1:627 WINTER ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2428
Mailing Address - Country:US
Mailing Address - Phone:503-585-4448
Mailing Address - Fax:503-585-4552
Practice Address - Street 1:627 WINTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2428
Practice Address - Country:US
Practice Address - Phone:503-585-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR733103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral