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Individual
LESLIE DIANE WEED FONNER
Active
Individual
LESLIE DIANE WEED FONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0000523
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014406
—
VT
01
—
1042317
CIGNA
VT
01
—
1255513719
BLUE CROSS/BLUE SHIELD OF VERMONT
VT
01
—
410724
TRICARE
—
01
—
989026C
MVP
VT
Enumeration date
11/27/2007
Last updated
11/19/2015
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