Clark, Leslie A.

Clark, Leslie A. is an individual health care provider with primary practice located at 7071 S. 13Th Street Suite 100, Oak Creek WI 53154. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Social Worker. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Clark, Leslie A. can be contacted via phone (414) 367-6698.

Contact Information

Primary practice address
7071 S. 13Th Street Suite 100 Oak Creek WI 53154
Phone: (414) 367-6698
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 16215-132 Wisconsin
Behavioral Health & Social Service Providers / Social Worker 104100000X 1180-226 Wisconsin
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 5204-125 Wisconsin

Profile Details

NPI number 1497092704
LBN Legal business name Clark, Leslie A.
Credentials LPC, CSAC, CIR, ICS-
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 7th, 2013
Last updated Apr 17th, 2024 - about 7 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497092704 NPPES
Wisconsin MEDICAID 100027595

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