Individual
TRACY LEESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 STEVENS ST SW, GRAND RAPIDS, MI 49507-1526
(855) 832-6727
Mailing address
17383 DEERING ST, LIVONIA, MI 48152-3703
(734) 828-4043
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
MI
247200000X
Other Technician
—
—
Other
Enumeration date
03/09/2015
Last updated
06/20/2022
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