1124732854 NPI number — LESLY JOCELYN POWELL SOTELO MSW, LGSW

Table of content: LESLY JOCELYN POWELL SOTELO MSW, LGSW (NPI 1124732854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124732854 NPI number — LESLY JOCELYN POWELL SOTELO MSW, LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL SOTELO
Provider First Name:
LESLY
Provider Middle Name:
JOCELYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LGSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124732854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 HAMPSHIRE AVE S APT 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-860-3395
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7601 WAYZATA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-223-8898
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  31697 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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