Healthcare Provider Details

I. General information

NPI: 1750550976
Provider Name (Legal Business Name): LESLIE SEWESTER LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S CLAIRBORNE RD SUITE B
OLATHE KS
66062-1776
US

IV. Provider business mailing address

302 S CLAIRBORNE RD SUITE B
OLATHE KS
66062-1776
US

V. Phone/Fax

Practice location:
  • Phone: 913-397-0300
  • Fax:
Mailing address:
  • Phone: 913-397-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5208
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number035
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: