Provider Demographics
NPI:1225217391
Name:MENHART, LESLEY NICOLE (MSW)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:NICOLE
Last Name:MENHART
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:NICOLE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:25 SHELDON BLVD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4209
Mailing Address - Country:US
Mailing Address - Phone:616-459-7062
Mailing Address - Fax:616-459-0392
Practice Address - Street 1:25 SHELDON BLVD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4209
Practice Address - Country:US
Practice Address - Phone:616-459-7062
Practice Address - Fax:616-459-0392
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010679001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical