Individual
LESLIE WALICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
28000 WOODWARD AVE STE 100, ROYAL OAK, MI 48067-0961
(248) 762-5590
Mailing address
28000 WOODWARD AVE STE 100, ROYAL OAK, MI 48067-0961
(248) 762-5590
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497760086
—
MI
Enumeration date
11/15/2019
Last updated
11/15/2019
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