Provider Demographics
NPI:1528816279
Name:LECLERC, RYAN DAVID
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:LECLERC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 MEADE CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1304
Mailing Address - Country:US
Mailing Address - Phone:734-968-3626
Mailing Address - Fax:
Practice Address - Street 1:12007 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1107
Practice Address - Country:US
Practice Address - Phone:313-867-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical