Provider Demographics
NPI:1518202639
Name:FORNERON, LESLEY LYNN (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:LYNN
Last Name:FORNERON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16206 W 143RD TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2568
Mailing Address - Country:US
Mailing Address - Phone:913-484-9263
Mailing Address - Fax:
Practice Address - Street 1:815 S CLAIRBORNE RD STE 200
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1700
Practice Address - Country:US
Practice Address - Phone:913-393-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical