Provider Demographics
NPI:1447880653
Name:GOLDEN, LESLIE E
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:GOLDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 ATWOOD AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5382
Mailing Address - Country:US
Mailing Address - Phone:608-772-3547
Mailing Address - Fax:
Practice Address - Street 1:2002 ATWOOD AVE STE 223
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5382
Practice Address - Country:US
Practice Address - Phone:608-772-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11076123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health