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General NPI Number Information
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NPI Number | 1548071392
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Entity Type | Individual
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Provider Name | DESIRAE MARIE LEGG
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 103 W 3RD ST # 524
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City | KALKASKA
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State | MI
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Zip | 49646-5107
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Country | US
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Telephone | 517-918-4567
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 CROFTON DR
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City | DEWITT
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State | MI
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Zip | 48820-7769
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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