Healthcare Provider Details

I. General information

NPI: 1790615995
Provider Name (Legal Business Name): LESLIE RAE JACKSON-HEINZE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 LAKOTA AVENUE N
CENTER ND
58530
US

IV. Provider business mailing address

324 LAKOTA AVENUE N
CENTER ND
58530
US

V. Phone/Fax

Practice location:
  • Phone: 701-301-9954
  • Fax:
Mailing address:
  • Phone: 701-301-9954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: