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NPI Code Detail

MEDICARE: MS. JO ELLEN LESLIE PH.D.

MEDICARE:  MS. JO ELLEN LESLIE  PH.D.
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
1103T00000XPsychologist3-0565TX

General Provider Information

NPI Number : 1619912359
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JO ELLEN LESLIE PH.D.
Provider Business Mailing Address
First Line : 1300 WINNIPEG DR
Second Line :
City : LEWISVILLE
State : TX
Zip : 75077-2980
Country : US
Telephone Number : 800-257-8715
Fax Number :
Provider Business Practice Location Address
First Line : 1300 WINNIPEG DR
Second Line :
City : LEWISVILLE
State : TX
Zip : 75077-2980
Country : US
Telephone Number : 800-257-8715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 07/08/2007

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Directions to “ MS. JO ELLEN LESLIE PH.D.” Practice Location

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