Provider Demographics
NPI:1083924237
Name:LESLIE E AULD INC.
Entity Type:Organization
Organization Name:LESLIE E AULD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:AULD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-481-2133
Mailing Address - Street 1:4572 S HAGADORN RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5385
Mailing Address - Country:US
Mailing Address - Phone:517-481-2133
Mailing Address - Fax:517-676-3438
Practice Address - Street 1:4572 S HAGADORN RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-481-2133
Practice Address - Fax:517-676-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI3458Medicare PIN