Provider Demographics
NPI:1497422372
Name:JURKOVSKI, LEZLEE JEAN (RBT)
Entity Type:Individual
Prefix:
First Name:LEZLEE
Middle Name:JEAN
Last Name:JURKOVSKI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BATTLEFIELD BLVD S UNIT 15309
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23328-1212
Mailing Address - Country:US
Mailing Address - Phone:757-769-9595
Mailing Address - Fax:833-901-0451
Practice Address - Street 1:1100 BATTLEFIELD BLVD S STE 15309
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6619
Practice Address - Country:US
Practice Address - Phone:757-769-9595
Practice Address - Fax:833-901-0451
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician