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General NPI Number Information
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NPI Number | 1295470797
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Entity Type | Individual
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Provider Name | ELLIESHA LESTER
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Gender | Female
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 18217 FIVE POINTS ST
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City | REDFORD
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State | MI
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Zip | 48240-1710
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Country | US
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Telephone | 313-459-6951
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Fax |
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Provider Business Mailing Address
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Address Line | 48591 S INTERSTATE 94 DR.
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City | BELLEVILLE
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State | MI
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Zip | 48111
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Country | US
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Telephone | 313-483-2345
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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