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General NPI Number Information
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NPI Number | 1043943798
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Entity Type | Individual
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Provider Name | LESLIE THEDE
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 1556 LONE OAK DR
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City | NEENAH
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State | WI
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Zip | 54956-6541
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Country | US
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Telephone | 920-418-1793
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Fax |
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Provider Business Mailing Address
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Address Line | 1556 LONE OAK DR
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City | NEENAH
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State | WI
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Zip | 54956-6541
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Country | US
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Telephone | 920-418-1793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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