Provider Demographics
NPI:1356473698
Name:WIEMER, LESLIE GERALYN (MSW)
Entity Type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:GERALYN
Last Name:WIEMER
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 1:5134 FLEMING
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125
Mailing Address - Country:US
Mailing Address - Phone:313-562-0839
Mailing Address - Fax:313-535-5266
Practice Address - Street 1:25945 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1808
Practice Address - Country:US
Practice Address - Phone:313-535-6560
Practice Address - Fax:313-535-5266
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9477571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical