Provider Demographics
NPI:1851766281
Name:KUMM-LALUZERNE, LESLEY
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:KUMM-LALUZERNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LESLEY
Other - Middle Name:LINN
Other - Last Name:LALUZERNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1415 E GREEN BAY ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3879
Mailing Address - Country:US
Mailing Address - Phone:715-526-3791
Mailing Address - Fax:
Practice Address - Street 1:1415 E GREEN BAY ST
Practice Address - Street 2:SUITE 111
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3879
Practice Address - Country:US
Practice Address - Phone:715-526-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst