Provider Demographics
NPI:1104105816
Name:LEAPSS AND BEYOND
Entity type:Organization
Organization Name:LEAPSS AND BEYOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICALAND NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ORTIZ-NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:559-824-8934
Mailing Address - Street 1:413 LINCOLN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1524
Mailing Address - Country:US
Mailing Address - Phone:559-314-4696
Mailing Address - Fax:
Practice Address - Street 1:413 LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1524
Practice Address - Country:US
Practice Address - Phone:559-314-4696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60221926103G00000X, 103TM1800X, 103TP2701X
WAPS60221926103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty