Provider Demographics
NPI:1093859654
Name:MORTLAND, LESLIE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JEAN
Last Name:MORTLAND
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR # 1300
Mailing Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA PEDIATRIC AND ADOLESCENT
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3610
Mailing Address - Fax:320-654-3647
Practice Address - Street 1:1900 CENTRACARE CIR # 1300
Practice Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA PEDIATRIC AND ADOLESCENT
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3610
Practice Address - Fax:320-654-3647
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2023-03-28
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Provider Licenses
StateLicense IDTaxonomies
FLTRN9066208000000X
AZ49019208000000X
WI559822080P0207X
MN53414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology