Provider Demographics
NPI:1851175574
Name:ACOSTA HERRERA, LESLIE GUADALUPE (MSW, CSWA, CHW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:GUADALUPE
Last Name:ACOSTA HERRERA
Suffix:
Gender:F
Credentials:MSW, CSWA, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14213 SE CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2741
Mailing Address - Country:US
Mailing Address - Phone:503-841-1359
Mailing Address - Fax:
Practice Address - Street 1:18633 SE STARK ST STE 401
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5468
Practice Address - Country:US
Practice Address - Phone:503-489-1760
Practice Address - Fax:503-489-1763
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker