Provider Demographics
NPI:1417286998
Name:BARRETT, LESLIE DIANE (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:DIANE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W GRAND BLVD STE 800
Mailing Address - Street 2:ENDOCRINOLOGY
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3141
Mailing Address - Country:US
Mailing Address - Phone:313-916-2127
Mailing Address - Fax:313-916-8343
Practice Address - Street 1:3031 W GRAND BLVD STE 800
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3141
Practice Address - Country:US
Practice Address - Phone:313-916-2127
Practice Address - Fax:313-916-8343
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00998681133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic