Provider Demographics
NPI:1720054505
Name:WIPF, LESLYE ANN (RD)
Entity Type:Individual
Prefix:
First Name:LESLYE
Middle Name:ANN
Last Name:WIPF
Suffix:
Gender:F
Credentials:RD
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 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1048
Practice Address - Country:US
Practice Address - Phone:605-322-7600
Practice Address - Fax:605-322-7601
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0270133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00234263OtherMEDICA
MN321J1BAOtherCC SYSTEMS/ BLUE PLUS
SD39507OtherSANFORD HEALTH PLAN
SDS100141Medicare PIN
SD39507OtherSANFORD HEALTH PLAN