Healthcare Provider Details

I. General information

NPI: 1689802688
Provider Name (Legal Business Name): RENEE VIRGINIA LESEA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 SILVERTON RD NE
SALEM OR
97301-0837
US

IV. Provider business mailing address

7515 FALCON CREST DR STE 200
REDMOND OR
97756-5014
US

V. Phone/Fax

Practice location:
  • Phone: 503-953-0310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL16453
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW63201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: