Provider Demographics
NPI:1508543943
Name:LESLIE KIBBE, MS, LLP, LLC
Entity Type:Organization
Organization Name:LESLIE KIBBE, MS, LLP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBBE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LLP
Authorized Official - Phone:231-715-1015
Mailing Address - Street 1:8834 E 34 RD STE 107
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9580
Mailing Address - Country:US
Mailing Address - Phone:231-715-1015
Mailing Address - Fax:
Practice Address - Street 1:8834 E 34 RD
Practice Address - Street 2:PMB #107
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9580
Practice Address - Country:US
Practice Address - Phone:231-715-1015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty