Provider Demographics
NPI:1679449672
Name:REPROGLE, LESLIE (LAC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:REPROGLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 E CEDAR PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3566
Mailing Address - Country:US
Mailing Address - Phone:480-213-2308
Mailing Address - Fax:
Practice Address - Street 1:4302 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-8808
Practice Address - Country:US
Practice Address - Phone:480-758-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-14405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty