Provider Demographics
NPI:1912533399
Name:SLEZAK-MOSER, LISA ANNE (MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:SLEZAK-MOSER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 WAYZATA BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1382
Mailing Address - Country:US
Mailing Address - Phone:952-835-6540
Mailing Address - Fax:952-835-6650
Practice Address - Street 1:8421 WAYZATA BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1382
Practice Address - Country:US
Practice Address - Phone:952-835-6540
Practice Address - Fax:952-835-6650
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist