Provider Demographics
NPI:1114062494
Name:YOUNG, LESLIE MARIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 CHEROKEE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-3301
Mailing Address - Country:US
Mailing Address - Phone:913-432-8189
Mailing Address - Fax:
Practice Address - Street 1:1301 N 47TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1705
Practice Address - Country:US
Practice Address - Phone:913-288-4237
Practice Address - Fax:913-287-0354
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-4602Medicare ID - Type Unspecified
KS3620000Medicare ID - Type Unspecified