LESLIE L GOODAVISH

MADISON, WI
NPI1730141987
Former NameLESLIE L STANDORF
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: WI  1933-23)
Additional Taxonomies363A00000X Physician Assistant
(Licence: MT  MED-PAC-LIC-79429)
Enumeration Date2006-04-04
Last Update Date2021-02-15
Business Address
LESLIE L GOODAVISH MMS PAC
4602 EASTPARK BLVD
MADISON, WI 53718-2002
Phone number: 608-263-8820
Mailing Address
LESLIE L GOODAVISH MMS PAC
7974 UW HEALTH CT
MIDDLETON, WI 53562-5531
Phone number: 608-829-5485