Provider Information for 1467990648
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MICHELLE LESAGONICZ LCSW
Sex: Female
NPI: 1467990648
Last Updated: 2017-02-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1467990648 | ||||||||
| Enumeration Date | 2017-02-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 2949 SOLDOTNA, AK 99669-2949 United States Phone: 907-260-7300 | Fax:907-260-7301 | ||||||||
| Primary Practice Address | 230 E MARYDALE AVE SOLDOTNA, AK 99669-7648 United States Phone: 907-260-7300 | Fax:907-260-7301 | ||||||||
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