1538319546 NPI number — LESLEY NICOLE WESPESSER MA, LPCC-S

Table of content: LESLEY NICOLE WESPESSER MA, LPCC-S (NPI 1538319546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538319546 NPI number — LESLEY NICOLE WESPESSER MA, LPCC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESPESSER
Provider First Name:
LESLEY
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538319546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARSAW
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41095-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-512-5401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 HWY 42W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARSAW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-567-1591
Provider Business Practice Location Address Fax Number:
859-567-1253
Provider Enumeration Date:
09/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  102162 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: KY-1605 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100277110 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 274092995 . This is a "IMPACT PLUS PROVIDER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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