Provider Demographics
NPI:1891822110
Name:HANNON, LESLIE (PSYD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HANNON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 GARDEN CTR STE 320
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1735
Mailing Address - Country:US
Mailing Address - Phone:720-933-2408
Mailing Address - Fax:
Practice Address - Street 1:80 GARDEN CTR STE 320
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1735
Practice Address - Country:US
Practice Address - Phone:720-560-4016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical