Provider Demographics
NPI:1679636534
Name:MAGNUS, LESLEY CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:CAROL
Last Name:MAGNUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58707
Mailing Address - Country:US
Mailing Address - Phone:701-858-3030
Mailing Address - Fax:701-858-3032
Practice Address - Street 1:500 UNIVERSITY AVENUE WEST
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58707
Practice Address - Country:US
Practice Address - Phone:701-858-3030
Practice Address - Fax:701-858-3032
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDMAG26058OtherBCBS
ND50927Medicaid