Provider Demographics
NPI:1699958132
Name:ESPESETH, LEANDRA RAE (MS)
Entity type:Individual
Prefix:
First Name:LEANDRA
Middle Name:RAE
Last Name:ESPESETH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 COPPER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1473
Mailing Address - Country:US
Mailing Address - Phone:505-266-5557
Mailing Address - Fax:505-266-5545
Practice Address - Street 1:5200 COPPER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1473
Practice Address - Country:US
Practice Address - Phone:505-266-5557
Practice Address - Fax:505-266-5545
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36450163WC0400X
NM417314235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No163WC0400XNursing Service ProvidersRegistered NurseCase Management