Provider Demographics
NPI:1578340428
Name:KALMOY, LEILA A
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:A
Last Name:KALMOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 HAZELWOOD ST APT 201
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2350
Mailing Address - Country:US
Mailing Address - Phone:612-757-3916
Mailing Address - Fax:
Practice Address - Street 1:1380 ENERGY LN STE 201
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5253
Practice Address - Country:US
Practice Address - Phone:763-346-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician