Healthcare Provider Details

I. General information

NPI: 1427576230
Provider Name (Legal Business Name): DEBBIE ANN LESLIE SVOBODNY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBBIE ANN LESLIE HART LSW

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 17TH AVE S STE 122
FARGO ND
58103-3372
US

IV. Provider business mailing address

524 12TH ST N
MOORHEAD MN
56560-2130
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2000
  • Fax:
Mailing address:
  • Phone: 612-214-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1041C0700X
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: