Healthcare Provider Details

I. General information

NPI: 1245462811
Provider Name (Legal Business Name): LESLEY JOHNSEN DAC, LAC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 12TH AVE S STE 203
GREAT FALLS MT
59405-4600
US

IV. Provider business mailing address

1301 12TH AVE S STE 203
GREAT FALLS MT
59405-4600
US

V. Phone/Fax

Practice location:
  • Phone: 406-403-2512
  • Fax:
Mailing address:
  • Phone: 406-403-2512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number131085
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: