Provider Demographics
NPI:1487026902
Name:LESNIAK, TAMMY (LMSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:LESNIAK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 HALL RD STE 422
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5716
Mailing Address - Country:US
Mailing Address - Phone:586-623-5095
Mailing Address - Fax:
Practice Address - Street 1:11111 HALL RD STE 422
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5716
Practice Address - Country:US
Practice Address - Phone:586-623-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010998871041C0700X
MI68011038041041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)