Provider Demographics
NPI:1588717599
Name:NILSSON, LESLIE ANN (MSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:NILSSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29895 GREENFIELD RD
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5867
Mailing Address - Country:US
Mailing Address - Phone:248-905-5230
Mailing Address - Fax:248-905-5233
Practice Address - Street 1:29895 GREENFIELD RD
Practice Address - Street 2:SUITE 104B
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5867
Practice Address - Country:US
Practice Address - Phone:248-905-5230
Practice Address - Fax:248-905-5233
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010357491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical