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General NPI Number Information
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NPI Number | 1508543943
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Entity Type | Organization
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Legal Business Name | LESLIE KIBBE, MS, LLP, LLC
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 8834 E 34 RD PMB #107
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City | CADILLAC
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State | MI
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Zip | 49601-9580
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Country | US
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Telephone | 231-715-1015
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Fax |
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Provider Business Mailing Address
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Address Line | 8834 E 34 RD STE 107
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City | CADILLAC
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State | MI
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Zip | 49601-9580
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Country | US
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Telephone | 231-715-1015
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE KIBBE
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Credential | MS, LLP
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Telephone | 231-715-1015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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