Individual
MS. LESLIE A. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSAC, CIR, ICS-
Contact information
Practice address
7071 S. 13TH STREET, SUITE 100, OAK CREEK, WI 53154
(414) 367-6698
Mailing address
11011 W. NORTH AVE., APT.309, WAUWATOSA, WI 53226
(414) 367-6698
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
16215-132
WI
101YM0800X
Mental Health Counselor
Primary
5204-125
WI
104100000X
Social Worker
1180-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100027595
—
WI
Enumeration date
01/07/2013
Last updated
04/17/2024
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