Individual
MS. LESLIE MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW MA
Contact information
Practice address
9000 WEST WISCONSIN AVENUE, MAIL STATION #750 PSYCHIATRY AND BEHAVIORAL MEDICINE CH, MILWAUKEE, WI 53201-1997
(262) 786-3492
Mailing address
835 PARK LANE, ELM GROVE, WI 53122
(262) 786-3492
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1906123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1906123
LICENSE
—
05
—
39503300
—
WI
Enumeration date
10/25/2006
Last updated
07/08/2007
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