Individual
LESLIE FIVEASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3001 S JACKSON ST, SAN ANGELO, TX 76904-5129
(325) 793-5497
Mailing address
11954 LAGOON LN, SAN ANGELO, TX 76904-4008
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/07/2018
Last updated
02/18/2021
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