Provider Demographics
NPI:1649727363
Name:LEISHMAN, ASHLIE I
Entity type:Individual
Prefix:MS
First Name:ASHLIE
Middle Name:
Last Name:LEISHMAN
Suffix:I
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 1:523 S 500 E APT 5
Mailing Address - Street 2:
Mailing Address - City:RIVER HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5529
Mailing Address - Country:US
Mailing Address - Phone:435-760-1367
Mailing Address - Fax:
Practice Address - Street 1:523 S 500 E APT 5
Practice Address - Street 2:
Practice Address - City:RIVER HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84321-5529
Practice Address - Country:US
Practice Address - Phone:435-760-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT196605349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist