Provider Demographics
NPI:1215215660
Name:MONARCH, LESLIE (LESLIE MONARCH LAC)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:MONARCH
Suffix:
Gender:X
Credentials:LESLIE MONARCH LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7979
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0212
Mailing Address - Country:US
Mailing Address - Phone:503-702-3206
Mailing Address - Fax:
Practice Address - Street 1:4400 SALEM DALLAS HWY NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3338
Practice Address - Country:US
Practice Address - Phone:503-208-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000340171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist