Provider Demographics
NPI:1689946394
Name:JOHNSON-SIMMONS, LESLIE JANE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JANE
Last Name:JOHNSON-SIMMONS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12528 IRELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-7810
Mailing Address - Country:US
Mailing Address - Phone:225-603-2050
Mailing Address - Fax:225-658-9368
Practice Address - Street 1:13700 PRIDE PORT HUDSON RD
Practice Address - Street 2:
Practice Address - City:PRIDE
Practice Address - State:LA
Practice Address - Zip Code:70770-9200
Practice Address - Country:US
Practice Address - Phone:225-658-0293
Practice Address - Fax:225-654-9368
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63381041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool