MEDICARE: STEPHANIE LEACH LSW

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	1041C0700X	Clinical Social Worker	S.2004969	OH

General Provider Information

NPI Number	:	1326624768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE LEACH LSW

Provider Business Mailing Address
First Line	:	5671 PRESTON WOODS RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4020
Country	:	US
Telephone Number	:	614-563-8551
Fax Number	:

Provider Business Practice Location Address
First Line	:	985 BETHEL RD STE A
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1990
Country	:	US
Telephone Number	:	614-596-3889
Fax Number	:

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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Directions to “ STEPHANIE LEACH LSW” Practice Location

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