Provider Demographics
NPI:1467165381
Name:LESCHUK, LYNN (LLMSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:LESCHUK
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 DIXIE HWY STE 155
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2095
Mailing Address - Country:US
Mailing Address - Phone:248-912-6353
Mailing Address - Fax:
Practice Address - Street 1:7640 DIXIE HWY STE 155
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2095
Practice Address - Country:US
Practice Address - Phone:248-912-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511166731041C0700X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other