Active NPI
Leslie A. Clark, LPC, CSAC, CIR, ICS-
- Mental Health Counselor
- Oak Creek, WI
National Provider Identifier
1497092704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5204-125
- Practice address
- 7071 S. 13TH Street
Suite 100
Oak Creek, WI 53154 - Phone
- (414) 367-6698
- NPI assigned
- Jan 7, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 16215-132 | WI | |
| Social Worker | 104100000X | 1180-226 | WI | |
| Mental Health Counselor | 101YM0800X | 5204-125 | WI | Primary |
Addresses
Primary practice location
7071 S. 13TH Street
Suite 100
Oak Creek, WI 53154
Mailing address
11011 W. North Ave.
Apt.309
Wauwatosa, WI 53226
Phone (414) 367-6698
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100027595 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 4, 2024 through Oct 4, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16215-132 | WI | MD | Mental Health Counselor |
| 1180-226 | WI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713312000000",
"number": "1497092704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11011 W. NORTH AVE.",
"address_2": "APT.309",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "53226",
"telephone_number": "414-367-6698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7071 S. 13TH STREET",
"address_2": "SUITE 100",
"city": "OAK CREEK",
"state": "WI",
"postal_code": "53154",
"telephone_number": "414-367-6698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "LESLIE",
"middle_name": "A.",
"name_prefix": "Ms.",
"credential": "LPC, CSAC, CIR, ICS-",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-07",
"last_updated": "2024-04-17",
"certification_date": "2024-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "16215-132",
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "WI",
"license": "1180-226",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WI",
"license": "5204-125",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100027595",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oak Creek, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.