Provider Demographics
NPI:1679608483
Name:LESLIE, CHELSY (RD, CD)
Entity type:Individual
Prefix:
First Name:CHELSY
Middle Name:
Last Name:LESLIE
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3315
Mailing Address - Country:US
Mailing Address - Phone:509-573-3575
Mailing Address - Fax:509-573-3582
Practice Address - Street 1:110 S 9TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3315
Practice Address - Country:US
Practice Address - Phone:509-573-3575
Practice Address - Fax:509-573-3582
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8438277Medicaid
8817LEOtherREGENCE