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General NPI Number Information
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NPI Number | 1396559357
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Entity Type | Individual
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Provider Name | LELAND CHARLES POTTER MSW
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Gender | Male
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Dates
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Enumeration Date | 02/01/2025
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Last Update Date | 02/01/2025
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Provider Practice Location Address
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Address Line | 20090 POLK ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-2064
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Country | US
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Telephone | 218-531-9669
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Fax | 855-761-1441
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Provider Business Mailing Address
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Address Line | 20090 POLK ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-2064
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Country | US
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Telephone | 218-531-9669
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Fax | 855-761-1441
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | A674180300
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License Number State | MN
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