Active NPI
Elizabeth Ann Leeberg, PH.D.
- Clinical Psychologist
- Bend, OR
National Provider Identifier
1619075876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1048
- Practice address
- 223 SE Davis Ave
Bend, OR 97702-1333 - Phone
- (541) 318-7023
- Fax
- (541) 318-0252
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1048 | OR | Primary |
Addresses
Primary practice location
223 SE Davis Ave
Bend, OR 97702-1333
Mailing address
223 SE Davis Ave
Bend, OR 97702-1333
Phone (541) 318-7023
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225238400000",
"number": "1619075876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 SE DAVIS AVE",
"city": "BEND",
"state": "OR",
"postal_code": "977021333",
"telephone_number": "541-318-7023",
"fax_number": "541-318-0252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 SE DAVIS AVE",
"city": "BEND",
"state": "OR",
"postal_code": "977021333",
"telephone_number": "541-318-7023",
"fax_number": "541-318-0252"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEEBERG",
"first_name": "ELIZABETH",
"middle_name": "ANN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2008-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "1048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.