Provider Demographics
NPI:1346399490
Name:FERGUSON, LESLIE W (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:W
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 HERRINGTON WOODS
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-9796
Mailing Address - Country:US
Mailing Address - Phone:859-748-5613
Mailing Address - Fax:
Practice Address - Street 1:420A W WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1836
Practice Address - Country:US
Practice Address - Phone:859-936-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0045468Medicare ID - Type UnspecifiedMEDICARE
KY0454Medicare ID - Type UnspecifiedMEDICARE