Provider Demographics
NPI:1093330458
Name:LESZCZYNSKI, TARREN STORM
Entity Type:Individual
Prefix:
First Name:TARREN
Middle Name:STORM
Last Name:LESZCZYNSKI
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 1:1700 BRONSON WAY
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1095
Mailing Address - Country:US
Mailing Address - Phone:269-382-3546
Mailing Address - Fax:
Practice Address - Street 1:1700 BRONSON WAY
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1095
Practice Address - Country:US
Practice Address - Phone:269-382-2546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist