Provider Demographics
NPI:1104624691
Name:LESNIAK, CHELSEA ANNE (MA, PPSC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ANNE
Last Name:LESNIAK
Suffix:
Gender:
Credentials:MA, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 TULLOCK ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-2168
Mailing Address - Country:US
Mailing Address - Phone:909-709-4415
Mailing Address - Fax:
Practice Address - Street 1:1330 AMELIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5363
Practice Address - Country:US
Practice Address - Phone:626-852-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210050088101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty