Provider Demographics
NPI:1942630124
Name:GOULD, LESLI (CLE)
Entity Type:Individual
Prefix:
First Name:LESLI
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 DURLAND DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0407
Mailing Address - Country:US
Mailing Address - Phone:406-651-4175
Mailing Address - Fax:
Practice Address - Street 1:3201 DURLAND DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0407
Practice Address - Country:US
Practice Address - Phone:406-651-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies