Provider Demographics
NPI:1881033413
Name:SCOTT, LESLIE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5069
Mailing Address - Country:US
Mailing Address - Phone:530-902-2243
Mailing Address - Fax:
Practice Address - Street 1:208 SUTTON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4144
Practice Address - Country:US
Practice Address - Phone:530-265-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 29355104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker