Provider Demographics
NPI:1891057840
Name:SCHLESKE, BRENDA LEA (LICSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEA
Last Name:SCHLESKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:1801 W ALCOTT AVE
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56538-0478
Mailing Address - Country:US
Mailing Address - Phone:218-332-5009
Mailing Address - Fax:218-739-1329
Practice Address - Street 1:1801 W ALCOTT AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2661
Practice Address - Country:US
Practice Address - Phone:218-332-5009
Practice Address - Fax:218-739-1329
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN185471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical