Healthcare Provider Details

I. General information

NPI: 1992356455
Provider Name (Legal Business Name): LEAH KAWLESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N MAYFAIR RD STE 650
MILWAUKEE WI
53226-1322
US

IV. Provider business mailing address

1070 CREEKSIDE DR UNIT 211
OCONOMOWOC WI
53066-8818
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-9304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: