MEDICARE: MRS. CRISTINA I LECLAIR PSY D LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301018287	MI
2	103T00000X	Psychologist	6301013013	MI

General Provider Information

NPI Number	:	1679766240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRISTINA I LECLAIR PSY D LP

Provider Business Mailing Address
First Line	:	1122 N LEROY ST STE A
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2789
Country	:	US
Telephone Number	:	819-373-5591
Fax Number	:

Provider Business Practice Location Address
First Line	:	1122 N LEROY ST STE A
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2789
Country	:	US
Telephone Number	:	810-373-5591
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	02/11/2026

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