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General NPI Number Information
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NPI Number | 1972663870
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Entity Type | Individual
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Provider Name | LESLIE ANN KONEK-SCHLAX LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 6121 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-2926
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Country | US
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Telephone | 262-652-7222
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Fax | 262-652-1734
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Provider Business Mailing Address
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Address Line | 4633 WASHINGTON RD
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City | KENOSHA
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State | WI
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Zip | 53144-4220
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Country | US
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Telephone | 262-652-7222
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Fax | 262-652-1734
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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 | 2531-123
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License Number State | WI
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