Provider Demographics
NPI:1689760332
Name:HIGGENBOTTOM, LESTER LESLIE (LCSW, LPC, CADCIII)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:LESLIE
Last Name:HIGGENBOTTOM
Suffix:
Gender:M
Credentials:LCSW, LPC, CADCIII
Other - Prefix:MR
Other - First Name:LES
Other - Middle Name:L
Other - Last Name:HIGGENBOTTOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LPC, CADCIII
Mailing Address - Street 1:1820 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403
Mailing Address - Country:US
Mailing Address - Phone:262-637-9933
Mailing Address - Fax:262-637-9933
Practice Address - Street 1:1820 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403
Practice Address - Country:US
Practice Address - Phone:262-637-9933
Practice Address - Fax:262-637-9933
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1012-125101YP2500X
WI2031-1231041C0700X, 104100000X
1041C0700X
WI793101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39227800Medicaid