Provider Demographics
NPI:1194804344
Name:GOLDMANN, LESLIE E (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:GOLDMANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LES
Other - Middle Name:E
Other - Last Name:GOLDMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:319 SW WASHINGTON ST
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2635
Mailing Address - Country:US
Mailing Address - Phone:503-227-4570
Mailing Address - Fax:503-227-2561
Practice Address - Street 1:319 SW WASHINGTON ST
Practice Address - Street 2:SUITE 1015
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2635
Practice Address - Country:US
Practice Address - Phone:503-227-4570
Practice Address - Fax:503-227-2561
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0852103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000TCHNICMedicare ID - Type Unspecified