Provider Demographics
NPI:1053906925
Name:UECKER, LESLIE M (LBSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:UECKER
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 MAIN AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1956
Mailing Address - Country:US
Mailing Address - Phone:701-289-7676
Mailing Address - Fax:
Practice Address - Street 1:415 2ND AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3060
Practice Address - Country:US
Practice Address - Phone:701-845-8518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X, 171M00000X
ND6691104100000X
ND145133747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant