Provider Demographics
NPI:1104051192
Name:PAHL, LESLEY LUCAS (BCBA)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:LUCAS
Last Name:PAHL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 MT BAKER AVE NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4835
Mailing Address - Country:US
Mailing Address - Phone:206-949-7640
Mailing Address - Fax:206-949-7640
Practice Address - Street 1:716 MT BAKER AVE NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4835
Practice Address - Country:US
Practice Address - Phone:206-949-7640
Practice Address - Fax:206-949-7640
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-02-0988103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst