Provider Demographics
NPI:1023644135
Name:KRANTZ, LESLIE SUE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:SUE
Last Name:KRANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8431 OAKPOINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9229
Mailing Address - Country:US
Mailing Address - Phone:517-416-1110
Mailing Address - Fax:
Practice Address - Street 1:8431 OAKPOINT DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9229
Practice Address - Country:US
Practice Address - Phone:517-416-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802063634171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator