Provider Demographics
NPI:1922682673
Name:PECK, LESLIE A (MSW,LICSWA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:PECK
Suffix:
Gender:F
Credentials:MSW,LICSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17503 25TH AVE NE UNIT R308
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4853
Mailing Address - Country:US
Mailing Address - Phone:425-280-6081
Mailing Address - Fax:
Practice Address - Street 1:17503 25TH AVE NE UNIT R308
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4853
Practice Address - Country:US
Practice Address - Phone:425-280-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC610811071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical