Provider Demographics
NPI:1407012685
Name:GROSSMANN BROWN, LESLIE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANNE
Last Name:GROSSMANN BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE WEST SUITE N 385
Mailing Address - Street 2:AVALON ST. ANTHONY PARK MERIDIAN BEHAVIORAL HEALTH
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2803
Mailing Address - Country:US
Mailing Address - Phone:612-326-7579
Mailing Address - Fax:877-367-1715
Practice Address - Street 1:1821 UNIVERSITY AVE W STE N385
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-647-0095
Practice Address - Fax:651-647-9147
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN244301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1952766651Medicaid
MN140712685Medicaid
MN205557491Medicaid
MN205557491Medicaid
1952766651Medicare NSC