Healthcare Provider Details

I. General information

NPI: 1346780665
Provider Name (Legal Business Name): LESLIE ANNE TRENTHAM LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 FULTON ST E STE 2
GRAND RAPIDS MI
49503-3562
US

IV. Provider business mailing address

1039 MERRIFIELD ST SE
GRAND RAPIDS MI
49507-3339
US

V. Phone/Fax

Practice location:
  • Phone: 616-256-0659
  • Fax:
Mailing address:
  • Phone: 616-256-0659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801116478
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: