Provider Demographics
NPI:1689815649
Name:LEBLANC, JENNIFER A (CAC-R)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:CAC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3740
Mailing Address - Country:US
Mailing Address - Phone:906-632-5200
Mailing Address - Fax:906-632-5276
Practice Address - Street 1:2864 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3740
Practice Address - Country:US
Practice Address - Phone:906-632-5200
Practice Address - Fax:906-632-5276
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)