Provider Demographics
NPI:1366582447
Name:SPENCER, LESLIE (RN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13213 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-6302
Mailing Address - Country:US
Mailing Address - Phone:586-939-4374
Mailing Address - Fax:586-939-4783
Practice Address - Street 1:13213 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312
Practice Address - Country:US
Practice Address - Phone:586-939-4374
Practice Address - Fax:586-939-4783
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI614535171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator