Provider Demographics
NPI:1063596377
Name:LESLIE, GAIL H (AUD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:H
Last Name:LESLIE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 10TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3317
Mailing Address - Country:US
Mailing Address - Phone:541-686-3505
Mailing Address - Fax:541-686-9067
Practice Address - Street 1:401 E 10TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3317
Practice Address - Country:US
Practice Address - Phone:541-686-3505
Practice Address - Fax:541-686-9067
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR20094231H00000X, 237600000X
ORHASP038758237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269654Medicaid
OR325596000001OtherPROVIDENCE MEDICARE EXTRA
ORJ177301OtherPACIFICSOURCE
OR416315Medicaid
OR93109519997401A002OtherTRICARE/TRIWEST
ORR00WCPDHBMedicare PIN