Individual
INGRID LECKLITER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2825 50TH ST, UCDHS- M.I.N.D. INSTUTUTE, SACRAMENTO, CA 95817-2308
(916) 703-0255
(916) 703-0243
Mailing address
2825 50TH ST, UCDHS- M.I.N.D. INSTUTUTE, SACRAMENTO, CA 95817-2308
(916) 703-0255
(916) 703-0243
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY 17240
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007980A
UCDHS PROVIDER #
CA
01
—
0665
PSYCHOLOGIST LICENSE #
OR
01
—
GR002104M
MEDI-CAL GROUP NUMBER
CA
01
—
PSY 17240
PSYCHOLOGIST LICENSE
CA
Enumeration date
11/28/2005
Last updated
07/09/2007
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