Individual
LESLIE WAYNE HOLBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
(541) 830-3516
Mailing address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
(541) 830-3516
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW00003281
CERTIFIED PEER SPECIALIST
OR
Enumeration date
09/06/2023
Last updated
09/07/2023
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