Provider Demographics
NPI:1972790459
Name:LEJEUNE, NELDA KAY
Entity Type:Individual
Prefix:MRS
First Name:NELDA
Middle Name:KAY
Last Name:LEJEUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PIPER BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215-3039
Mailing Address - Country:US
Mailing Address - Phone:313-823-6559
Mailing Address - Fax:
Practice Address - Street 1:8718 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48211-1241
Practice Address - Country:US
Practice Address - Phone:313-823-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010666701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPO6290001Medicare PIN