Provider Demographics
NPI:1942948302
Name:HAUPT, LESLIE DIANE
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:DIANE
Last Name:HAUPT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LANSING DR SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-2956
Mailing Address - Country:US
Mailing Address - Phone:505-974-9716
Mailing Address - Fax:
Practice Address - Street 1:300 LANSING DR SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-2956
Practice Address - Country:US
Practice Address - Phone:505-974-9716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician