Healthcare Provider Details

I. General information

NPI: 1447880653
Provider Name (Legal Business Name): LESLIE E GOLDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 ATWOOD AVE STE 223
MADISON WI
53704-5382
US

IV. Provider business mailing address

2002 ATWOOD AVE STE 223
MADISON WI
53704-5382
US

V. Phone/Fax

Practice location:
  • Phone: 608-772-3547
  • Fax:
Mailing address:
  • Phone: 608-772-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11076123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: