Provider Demographics
NPI:1932966215
Name:CUSHMAN, LEAH EILEEN
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:EILEEN
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:EILEEN
Other - Last Name:CUSHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10115 HOLLY DR APT B201
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-8747
Mailing Address - Country:US
Mailing Address - Phone:360-722-4543
Mailing Address - Fax:
Practice Address - Street 1:8725 S 212TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-1921
Practice Address - Country:US
Practice Address - Phone:425-658-3016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician