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NPI Code Detail

MEDICARE: LESLIE LARSEN

MEDICARE: LESLIE LARSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1133CO

General Provider Information

NPI Number : 1053865915
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE LARSEN
Provider Business Mailing Address
First Line : 211 S 21ST AVE
Second Line :
City : BRIGHTON
State : CO
Zip : 80601-2581
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 211 S 21ST AVE
Second Line :
City : BRIGHTON
State : CO
Zip : 80601-2581
Country : US
Telephone Number : 303-655-9065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2016
Last Update Date : 08/09/2016

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Directions to “ LESLIE LARSEN ” Practice Location

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