Provider Demographics
NPI:1962191452
Name:LESARGE, THERESA (BSW)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:LESARGE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 RAMSDELL DR NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8075
Mailing Address - Country:US
Mailing Address - Phone:616-745-2931
Mailing Address - Fax:
Practice Address - Street 1:6420 RAMSDELL DR NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-8075
Practice Address - Country:US
Practice Address - Phone:616-745-2931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator