Provider Demographics
NPI:1659526804
Name:SPEER, LESLIE ADRIENNE (PHD, BCBA, NCSP, LP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ADRIENNE
Last Name:SPEER
Suffix:
Gender:F
Credentials:PHD, BCBA, NCSP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 S VAL VISTA DR BLDG 4
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1675
Mailing Address - Country:US
Mailing Address - Phone:480-608-4640
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR BLDG 4
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1675
Practice Address - Country:US
Practice Address - Phone:480-608-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist