Provider Demographics
NPI:1245669530
Name:HALL, LESLIE JANE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JANE
Last Name:HALL
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 1:2395 JOLLY RD STE 195
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5987
Mailing Address - Country:US
Mailing Address - Phone:517-336-4335
Mailing Address - Fax:517-548-0498
Practice Address - Street 1:2395 JOLLY RD STE 195
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5987
Practice Address - Country:US
Practice Address - Phone:517-336-4335
Practice Address - Fax:517-548-0498
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010830261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical