Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Leslie Gustafson, PA-C

Individual provider Physician Assistant · NPI 1922405059

Leslie Gustafson, PA-C is a Physician Assistant in Lake Oswego, Oregon. Qualified in 2014, 12 years ago. Practices with Providence Health and Services Oregon, a 1,426-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Oregon.

Years since qualifying
12
Licensed in
OR
In the registry since
2014
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

17550 Provost St Ste 201
Lake Oswego, OR 97034-5199
Phone: (503) 872-2440
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 115 Ne May Ln, McMinnville, OR 97128-9272 — (503) 472-1338

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA170542 (OR)

Record details

NPI number1922405059
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 4, 2014
Last updated in NPPESFebruary 12, 2021
Certification dateFebruary 12, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Providence Health And Services Oregon — 1426 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Lake Oswego