Provider Demographics
NPI:1922117043
Name:SANDERS, LESLIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:SANDERS
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:PO BOX 50004
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-5004
Mailing Address - Country:US
Mailing Address - Phone:314-805-1424
Mailing Address - Fax:314-429-2230
Practice Address - Street 1:2105 BRYANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-2201
Practice Address - Country:US
Practice Address - Phone:314-805-1424
Practice Address - Fax:314-429-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0032951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical