Provider Demographics
NPI:1386113967
Name:LEEDEN, JANELLE NICOLE (PSS)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:NICOLE
Last Name:LEEDEN
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:NICOLE
Other - Last Name:WRIGLESWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12493 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9745
Mailing Address - Country:US
Mailing Address - Phone:541-977-3343
Mailing Address - Fax:
Practice Address - Street 1:4275 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4086
Practice Address - Country:US
Practice Address - Phone:541-480-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000003048175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist