Provider Demographics
NPI:1174102602
Name:LESLIE, ALICIA ARDITH
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ARDITH
Last Name:LESLIE
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 1:1300 N 12TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2858
Mailing Address - Country:US
Mailing Address - Phone:602-521-3050
Mailing Address - Fax:602-521-3046
Practice Address - Street 1:1300 N 12TH ST STE 320
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2858
Practice Address - Country:US
Practice Address - Phone:602-521-3050
Practice Address - Fax:602-521-3046
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program