Provider Demographics
NPI:1760769087
Name:LESAUVAGE, VONDA (LBSW)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:
Last Name:LESAUVAGE
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22800 HALL RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-4804
Mailing Address - Country:US
Mailing Address - Phone:517-676-5405
Mailing Address - Fax:517-676-5460
Practice Address - Street 1:22800 HALL RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-4804
Practice Address - Country:US
Practice Address - Phone:517-676-5405
Practice Address - Fax:517-676-5460
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802058080104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker