Healthcare Provider Details

I. General information

NPI: 1023100377
Provider Name (Legal Business Name): LESLIE CAROL LIEN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 16TH ST W SUITE 100
DICKINSON ND
58601-4660
US

IV. Provider business mailing address

786 ALBANY ST
DELTA CO
81416-6401
US

V. Phone/Fax

Practice location:
  • Phone: 701-225-0767
  • Fax: 701-225-7123
Mailing address:
  • Phone: 701-590-2598
  • Fax: 701-225-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number890
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: