Provider Demographics
NPI:1255114351
Name:LESLIE, ALISHA DAWN (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:DAWN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:DAWN
Other - Last Name:HOLDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 SGT ED HOLCOMB BLVD S STE 46
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1130
Mailing Address - Country:US
Mailing Address - Phone:936-596-0445
Mailing Address - Fax:
Practice Address - Street 1:945 SGT ED HOLCOMB BLVD S STE 46
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1130
Practice Address - Country:US
Practice Address - Phone:936-596-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87962133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered