Provider Demographics
NPI:1598234239
Name:LESOFSKI, EDWARD (INTERN PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LESOFSKI
Suffix:
Gender:M
Credentials:INTERN PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16915
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-6915
Mailing Address - Country:US
Mailing Address - Phone:406-465-9504
Mailing Address - Fax:
Practice Address - Street 1:400 EXPRESSWAY STE D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1536
Practice Address - Country:US
Practice Address - Phone:406-465-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist