Provider Demographics
NPI:1720521933
Name:LEE, LESLIE SUTTON (RD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SUTTON
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ANNE
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1124 COLUMBIA ST
Practice Address - Street 2:STE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2053
Practice Address - Country:US
Practice Address - Phone:206-215-2090
Practice Address - Fax:206-215-3099
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60715446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered