Provider Demographics
NPI:1386357218
Name:MCCOY, LESLIE (CHW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:811 2ND ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3558
Mailing Address - Country:US
Mailing Address - Phone:320-631-7297
Mailing Address - Fax:
Practice Address - Street 1:811 2ND ST SE STE A
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3558
Practice Address - Country:US
Practice Address - Phone:203-631-7297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker