# LEAPSS AND BEYOND

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104105816
- **Authorized official:** DR. EDWYN W ORTIZ-NANCE PSYD (CLINICALAND NEUROPSYCHOLOGIST)
- **Authorized official phone:** (559) 824-8934

## Contact information

- **Practice address:** 413 LINCOLN AVE STE A, MUKILTEO, WA 98275-1524
- **Practice address phone:** (559) 314-4696
- **Mailing address:** 413 LINCOLN AVE STE A, MUKILTEO, WA 98275-1524
- **Mailing address phone:** (559) 314-4696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103G00000X | Clinical Neuropsychologist | PY60221926 | WA | — |
| 103T00000X | Psychologist | PS60221926 | WA | Yes |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | PY60221926 | WA | — |
| 103TP2701X | Group Psychotherapy Psychologist | PY60221926 | WA | — |

## Other

- **Enumeration date:** 08/11/2011
- **Last updated:** 08/11/2011