Provider Demographics
NPI:1528236833
Name:LEIBSOHN, JACQUELINE WENDY (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:WENDY
Last Name:LEIBSOHN
Suffix:
Gender:F
Credentials:PHD
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 222000
Mailing Address - Street 2:SEATTLE UNIVERSITY, LOYOLA 212
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122
Mailing Address - Country:US
Mailing Address - Phone:206-296-5766
Mailing Address - Fax:206-296-1892
Practice Address - Street 1:1820 12TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2438
Practice Address - Country:US
Practice Address - Phone:206-296-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist