Provider Demographics
NPI:1700099744
Name:LESLIE, REBECCA ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:LESLIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MAIN
Mailing Address - Street 2:PO BOX 888
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827
Mailing Address - Country:US
Mailing Address - Phone:907-766-6383
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 888
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-0888
Practice Address - Country:US
Practice Address - Phone:907-766-6383
Practice Address - Fax:907-766-2977
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK123550101YP2500X
SDLPC7349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional