Provider Demographics
NPI:1932744455
Name:RICKMAN, LESLEY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:
Last Name:RICKMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 OKEENA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8886
Mailing Address - Country:US
Mailing Address - Phone:731-394-0598
Mailing Address - Fax:
Practice Address - Street 1:109 E LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-6203
Practice Address - Country:US
Practice Address - Phone:901-930-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN124061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical