Individual
ELLEN K LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 S GREEN BAY RD, MT PLEASANT, WI 53406-4402
(855) 989-5422
Mailing address
4830 W KNOLLWOOD DR, MOUNT PLEASANT, WI 53403-3954
(262) 598-9990
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
4335-16
WI
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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