Healthcare Provider Details

I. General information

NPI: 1669430237
Provider Name (Legal Business Name): LESLIE JOHNSON MEYER MA LP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LESLIE A JOHNSON

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 GOLDEN VALLEY ROAD COURAGE CENTER
GOLDEN VALLEY MN
55422-4298
US

IV. Provider business mailing address

3915 GOLDEN VALLEY ROAD COURAGE CENTER
GOLDEN VALLEY MN
55422-4298
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-0493
  • Fax: 763-520-0355
Mailing address:
  • Phone: 763-520-0493
  • Fax: 763-520-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3588
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberLP3588
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: