Provider Demographics
NPI:1154490290
Name:LESSLEY, SUSAN SIRIANNI (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SIRIANNI
Last Name:LESSLEY
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TWELVE OAKS CENTER DR
Mailing Address - Street 2:SUITE 642G
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-4501
Mailing Address - Country:US
Mailing Address - Phone:612-581-7381
Mailing Address - Fax:
Practice Address - Street 1:600 TWELVE OAKS CENTER DR
Practice Address - Street 2:SUITE 642G
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4501
Practice Address - Country:US
Practice Address - Phone:612-581-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist