Healthcare Provider Details

I. General information

NPI: 1447072707
Provider Name (Legal Business Name): LESLIE BOYLE-MILROY LAMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE ANN JOHNSON

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E 78TH ST STE 100
BLOOMINGTON MN
55420-1402
US

IV. Provider business mailing address

3849 40TH AVE S
MINNEAPOLIS MN
55406-3438
US

V. Phone/Fax

Practice location:
  • Phone: 952-854-5034
  • Fax: 952-854-5363
Mailing address:
  • Phone: 605-760-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4647
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: