Provider Demographics
NPI:1902362379
Name:OLMSTEAD, LESLIE YVONNE (MSW, BSL)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:YVONNE
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:MSW, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-1922
Mailing Address - Country:US
Mailing Address - Phone:570-295-0486
Mailing Address - Fax:
Practice Address - Street 1:1316 LOCUST ST
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-1922
Practice Address - Country:US
Practice Address - Phone:570-295-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003525103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst