Provider Demographics
NPI:1083232581
Name:LESCALLETTE-BUTTON, LESLIE CAROL
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:CAROL
Last Name:LESCALLETTE-BUTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BEECH AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1610
Mailing Address - Country:US
Mailing Address - Phone:717-418-1594
Mailing Address - Fax:
Practice Address - Street 1:1335 E CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1117
Practice Address - Country:US
Practice Address - Phone:717-606-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional