Healthcare Provider Details

I. General information

NPI: 1760769087
Provider Name (Legal Business Name): VONDA LESAUVAGE LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22800 HALL RD SUITE 240
CLINTON TOWNSHIP MI
48036-4804
US

IV. Provider business mailing address

22800 HALL RD SUITE 240
CLINTON TOWNSHIP MI
48036-4804
US

V. Phone/Fax

Practice location:
  • Phone: 517-676-5405
  • Fax: 517-676-5460
Mailing address:
  • Phone: 517-676-5405
  • Fax: 517-676-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802058080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: