Provider Demographics
NPI:1154384006
Name:KEPLER LESKE, BRENDA SUE (PSYD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:KEPLER LESKE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:SUE
Other - Last Name:LESKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4785 HAYES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-7364
Mailing Address - Country:US
Mailing Address - Phone:608-242-7160
Mailing Address - Fax:608-242-7153
Practice Address - Street 1:5315 WALL ST STE 290
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-7965
Practice Address - Country:US
Practice Address - Phone:608-236-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2355-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43577300Medicaid
WI43577300Medicaid
WI000284685Medicare ID - Type UnspecifiedMEDICARE PROVIDER #