Provider Demographics
NPI:1194582452
Name:HERRGUTH, LESLIE (LLMSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HERRGUTH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:BARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:13301 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:MI
Mailing Address - Zip Code:48808
Mailing Address - Country:US
Mailing Address - Phone:517-528-5957
Mailing Address - Fax:
Practice Address - Street 1:6920 SOUTH CEDAR STREET
Practice Address - Street 2:SUITE 11
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-528-5957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511178231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical