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General NPI Number Information
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NPI Number | 1649196551
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Entity Type | Individual
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Provider Name | TRACY LEYSEN
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Gender |
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 820 2ND AVE N STE 2
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City | WINDOM
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State | MN
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Zip | 56101-1766
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Country | US
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Telephone | 507-831-3717
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 MURRAY AVE
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City | SLAYTON
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State | MN
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Zip | 56172-2001
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Country | US
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Telephone |
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Fax |
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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 | 125J00000X
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Taxonomy Name | Dental Therapist
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License Number | DT196
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License Number State | MN
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