Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | WA |
NPI | 1003156183 |
---|---|
Provider Name | Leslie Kincade |
First Address | Yakima, WA 98907-0959 |
Second Address | Yakima, WA 98902-3546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2013 |
Last Update Date | 26/02/2013 |