Provider Demographics
NPI:1750578712
Name:DEJESSE, LEIGHANN DENISE
Entity type:Individual
Prefix:MS
First Name:LEIGHANN
Middle Name:DENISE
Last Name:DEJESSE
Suffix:
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 1:90 ALHAMBRA ST
Mailing Address - Street 2:APT. 401
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2116
Mailing Address - Country:US
Mailing Address - Phone:415-971-9090
Mailing Address - Fax:
Practice Address - Street 1:90 ALHAMBRA ST
Practice Address - Street 2:APT. 401
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2116
Practice Address - Country:US
Practice Address - Phone:415-971-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY26322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical