Provider Demographics
NPI:1346371010
Name:CLEGG, ESTHER C (MA)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:C
Last Name:CLEGG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3312
Mailing Address - Country:US
Mailing Address - Phone:248-730-5540
Mailing Address - Fax:
Practice Address - Street 1:37634 ENTERPRISE CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3440
Practice Address - Country:US
Practice Address - Phone:248-553-0902
Practice Address - Fax:248-553-2632
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL901731101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor