Provider Demographics
NPI:1154432326
Name:BREWER, LESLAE ANNE (HIS)
Entity type:Individual
Prefix:
First Name:LESLAE
Middle Name:ANNE
Last Name:BREWER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 S MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-1376
Mailing Address - Country:US
Mailing Address - Phone:541-938-6893
Mailing Address - Fax:541-938-6993
Practice Address - Street 1:8382 W GAGE BLVD STE Q
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8104
Practice Address - Country:US
Practice Address - Phone:509-783-1648
Practice Address - Fax:541-938-6993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA60965314237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist