Healthcare Provider Details

I. General information

NPI: 1396904900
Provider Name (Legal Business Name): LEAH HODGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 MERIDIAN AVE
SAN JOSE CA
95125-4350
US

IV. Provider business mailing address

1333 MERIDIAN AVE
SAN JOSE CA
95125-5212
US

V. Phone/Fax

Practice location:
  • Phone: 408-445-3400
  • Fax: 408-998-8043
Mailing address:
  • Phone: 408-445-3400
  • Fax: 408-269-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: