Provider Demographics
NPI:1922197110
Name:SHOJI, LESLIE S (MS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:SHOJI
Suffix:
Gender:F
Credentials:MS
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 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-226-3320
Mailing Address - Fax:530-226-3323
Practice Address - Street 1:499 HEMSTED DR
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0165
Practice Address - Country:US
Practice Address - Phone:530-226-3320
Practice Address - Fax:530-226-3323
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU831231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0008310Medicaid
P36185Medicare UPIN
CAZZZ21233ZMedicare ID - Type Unspecified