Provider Demographics
NPI:1023100377
Name:LIEN, LESLIE CAROL (SLP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:CAROL
Last Name:LIEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-6401
Mailing Address - Country:US
Mailing Address - Phone:701-590-2598
Mailing Address - Fax:701-225-7123
Practice Address - Street 1:227 16TH ST W
Practice Address - Street 2:SUITE 100
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4660
Practice Address - Country:US
Practice Address - Phone:701-225-0767
Practice Address - Fax:701-225-7123
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54839Medicaid
ND24573OtherBLUE CROSS
ND24573OtherBLUE CROSS