Provider Demographics
NPI:1336992478
Name:STANEK-NAULT, LESLIE JOEANNA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:JOEANNA
Last Name:STANEK-NAULT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8542 O LN
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-8935
Mailing Address - Country:US
Mailing Address - Phone:906-420-4644
Mailing Address - Fax:
Practice Address - Street 1:8542 O LN
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MI
Practice Address - Zip Code:49837-8935
Practice Address - Country:US
Practice Address - Phone:906-420-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223848101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional