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General NPI Number Information
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NPI Number | 1679397822
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Entity Type | Individual
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Provider Name | KENNISHA LESLEY
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Gender | Female
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 473 S CARNEGIE DR STE 200
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4201
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Country | US
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Telephone | 909-565-5431
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 382
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City | HIGHLAND
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State | CA
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Zip | 92346-0382
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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 | ASW118609
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License Number State | CA
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