Healthcare Provider Details

I. General information

NPI: 1871051698
Provider Name (Legal Business Name): LESA BRENNER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LESA BRENNER

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 E KILGORE RD STE B
PORTAGE MI
49002-1104
US

IV. Provider business mailing address

423 MONTROSE AVE
KALAMAZOO MI
49001-4225
US

V. Phone/Fax

Practice location:
  • Phone: 517-420-0394
  • Fax:
Mailing address:
  • Phone: 517-420-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801106485
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: