Provider Demographics
NPI:1487790242
Name:FORD, LESLIE COLLINS (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:COLLINS
Last Name:FORD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:COLLINS
Other - Last Name:BRUMBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:33000 S. MOLALLA FOREST ROAD
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038
Mailing Address - Country:US
Mailing Address - Phone:503-829-3380
Mailing Address - Fax:
Practice Address - Street 1:2130 SW 5TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4976
Practice Address - Country:US
Practice Address - Phone:503-238-0769
Practice Address - Fax:503-963-7711
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical