Provider Demographics
NPI:1134568983
Name:WILKINSON, LEA
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:WILKINSON
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 1:30508 N GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-1459
Mailing Address - Country:US
Mailing Address - Phone:313-550-3137
Mailing Address - Fax:
Practice Address - Street 1:25554 W 12 MILE RD
Practice Address - Street 2:#103
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8051
Practice Address - Country:US
Practice Address - Phone:313-550-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator