Healthcare Provider Details
I. General information
NPI: 1972596401
Provider Name (Legal Business Name): LESLIE DIANE ARMIGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/30/2005
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6050 STERLING CREEK RD
PORTAGE IN
46368-7752
US
IV. Provider business mailing address
PO BOX 1430
PORTAGE IN
46368-9230
US
V. Phone/Fax
- Phone: 219-763-8112
- Fax: 219-764-5380
- Phone: 219-763-8112
- Fax: 219-764-5380
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 34003347A |
| License Number State | IN |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: