Individual
BENNETT LEITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1900 CENTRACARE CIR STE 500, SAINT CLOUD, MN 56303-5000
(320) 253-2663
Mailing address
1900 CENTRACARE CIR STE 500, SAINT CLOUD, MN 56303-5000
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
727-16
ND
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/14/2017
Last updated
04/21/2022
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