Provider Demographics
NPI:1477704724
Name:LESLIE-IRISH, JANICE BARBARA (MS)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:BARBARA
Last Name:LESLIE-IRISH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N ANN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2704
Mailing Address - Country:US
Mailing Address - Phone:414-371-0821
Mailing Address - Fax:414-586-0828
Practice Address - Street 1:2266 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6319
Practice Address - Country:US
Practice Address - Phone:414-289-0937
Practice Address - Fax:414-289-0938
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1941125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional