Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1386 | OR |
Y | 103TC0700X | Clinical Psychologist | 1386 | OR |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1386 | OR |
N | 103TR0400X | Rehabilitation Psychologist | 1386 | OR |
NPI | 1235228099 |
---|---|
Provider Name | Dr. Leslie Elizabeth Carter |
First Address | Tigard, OR 97223-6588 |
Second Address | Tigard, OR 97223-6588 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 09/02/2016 |