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NPI Code Detail

MEDICARE: MRS. LESLIE RAE TESTER

MEDICARE: MRS. LESLIE RAE TESTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
21041C0700XClinical Social Worker11511AK

General Provider Information

NPI Number : 1174784862
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LESLIE RAE TESTER
Provider Business Mailing Address
First Line : 2800 HORSESHOE WAY
Second Line :
City : NORTH POLE
State : AK
Zip : 99705-6121
Country : US
Telephone Number : 907-488-1017
Fax Number :
Provider Business Practice Location Address
First Line : 1825 MARIKA RD
Second Line :
City : FAIRBANKS
State : AK
Zip : 99709-5521
Country : US
Telephone Number : 907-474-0890
Fax Number : 907-474-3621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2008
Last Update Date : 12/12/2022

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Directions to “ MRS. LESLIE RAE TESTER ” Practice Location

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