Provider Demographics
NPI:1881452217
Name:LESKE, NICHOLAS JAMES
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:LESKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-1255
Mailing Address - Country:US
Mailing Address - Phone:248-807-7963
Mailing Address - Fax:
Practice Address - Street 1:5130 ROSE HILL BLVD
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9507
Practice Address - Country:US
Practice Address - Phone:248-531-2403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist