Healthcare Provider Details

I. General information

NPI: 1780592964
Provider Name (Legal Business Name): LESLIE DENARDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S RAISINVILLE RD
MONROE MI
48161-9047
US

IV. Provider business mailing address

12308 STONY CREEK RD
MILAN MI
48160-9506
US

V. Phone/Fax

Practice location:
  • Phone: 734-322-2700
  • Fax:
Mailing address:
  • Phone: 734-678-8674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000603
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: