Healthcare Provider Details

I. General information

NPI: 1568955748
Provider Name (Legal Business Name): LEAH SZEMBORSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 E PERSHING ST.
APPLETON WI
54911
US

IV. Provider business mailing address

1109 E PERSHING ST.
APPLETON WI
54911
US

V. Phone/Fax

Practice location:
  • Phone: 715-252-0401
  • Fax:
Mailing address:
  • Phone: 715-252-0401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4997
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4997-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: