Provider Demographics
NPI:1457575524
Name:CHAPIN, LESLEY BAIRD (PSYD)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:BAIRD
Last Name:CHAPIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 INTERNATIONAL LN STE 119
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3154
Mailing Address - Country:US
Mailing Address - Phone:608-467-8870
Mailing Address - Fax:608-467-6735
Practice Address - Street 1:2317 INTERNATIONAL LN STE 119
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3154
Practice Address - Country:US
Practice Address - Phone:608-302-9752
Practice Address - Fax:608-467-6735
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3043-57103T00000X, 103T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1457575524Medicaid