1235238726 NPI number — LESLIE B ANDERSON MSW, ACSW, LCSW

Table of content: LESLIE B ANDERSON MSW, ACSW, LCSW (NPI 1235238726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235238726 NPI number — LESLIE B ANDERSON MSW, ACSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
LESLIE
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, ACSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ANDERSON
Provider Other First Name:
LESLIE
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235238726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 W CAROLINA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICKASHA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73018-6902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-224-1882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 WILSON STREET
Provider Second Line Business Practice Location Address:
REYNOLDS ARMY COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
FORT SILL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-442-2836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SO3581 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 3486 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)