Provider Demographics
NPI:1407402076
Name:OLDENBURG, LEAH ASHLEY
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ASHLEY
Last Name:OLDENBURG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 E WEST MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3801
Mailing Address - Country:US
Mailing Address - Phone:248-858-7766
Mailing Address - Fax:248-624-0368
Practice Address - Street 1:2045 E WEST MAPLE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3801
Practice Address - Country:US
Practice Address - Phone:248-858-7766
Practice Address - Fax:248-624-0368
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical