Provider Demographics
NPI:1033693312
Name:COLE, LESLIE J (BS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:COLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 1ST ST STE 270
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1770
Mailing Address - Country:US
Mailing Address - Phone:715-246-4840
Mailing Address - Fax:
Practice Address - Street 1:3610 OAKWOOD MALL DR STE 104
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-9084
Practice Address - Country:US
Practice Address - Phone:715-246-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional