1205197860 NPI number — ASHLEY LAFAYE LEOLANI USITA M.A.

Table of content: ASHLEY LAFAYE LEOLANI USITA M.A. (NPI 1205197860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205197860 NPI number — ASHLEY LAFAYE LEOLANI USITA M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
USITA
Provider First Name:
ASHLEY
Provider Middle Name:
LAFAYE LEOLANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRIS
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
LAFAYE LEOLANI
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205197860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10775 PIONEER TRL STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUCKEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96161-0234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-814-9604
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21212 119TH ST E APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-7729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-896-7829
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2012

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: 101YM0800X , with the licence number:  LH60723564 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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