Provider Demographics
NPI:1154345171
Name:LEONARD, MARSHA SUSAN (MFT)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:SUSAN
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18441 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7105
Mailing Address - Country:US
Mailing Address - Phone:415-944-0142
Mailing Address - Fax:
Practice Address - Street 1:10151 SE SUNNYSIDE RD STE 480
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5705
Practice Address - Country:US
Practice Address - Phone:415-499-6894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT37915106H00000X
ORT0916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist