NPI 1154579902 · live from the CMS NPI Registry
Leslie A Blanchard, Ph.D.
Psychologist in Russellville, AR. National Provider Identifier 1154579902, active.
NPI record
| NPI | 1154579902 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Psychologist 103T00000X |
| Practice location | 3101 West 2nd Ct, Russellville, AR 72801 |
| Practice phone | 479-567-5654 |
| Mailing address | P.O. Box 10323, Russellville, AR 72812 |
| Enumerated | September 5, 2008 |
| Last updated | January 8, 2018 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Clinical | 103TC0700X | 07-7E (AR) |
| Psychologist primary | 103T00000X | 09-16P (AR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.