Provider Demographics
NPI:1154872596
Name:SLEIGHT -HENNIG, LISA BETH
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:BETH
Last Name:SLEIGHT -HENNIG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:BETH
Other - Last Name:HENNIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:331 ALBERTA DR STE 110
Mailing Address - Street 2:LIBERTY POST
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1813
Mailing Address - Country:US
Mailing Address - Phone:716-204-5925
Mailing Address - Fax:716-204-5926
Practice Address - Street 1:331 ALBERTA DR STE 110
Practice Address - Street 2:LIBERTY POST
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1813
Practice Address - Country:US
Practice Address - Phone:716-204-5925
Practice Address - Fax:716-204-5926
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency