Provider Demographics
NPI:1336201730
Name:LEISTIKO, SANDIE (MSW, MHP)
Entity Type:Individual
Prefix:
First Name:SANDIE
Middle Name:
Last Name:LEISTIKO
Suffix:
Gender:F
Credentials:MSW, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SEATTLE MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:1404 CENTRAL AVE S
Practice Address - Street 2:SUITE 113
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7433
Practice Address - Country:US
Practice Address - Phone:253-876-7620
Practice Address - Fax:253-876-7621
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00042775101YP2500X
WALW600731521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional