Healthcare Provider Details

I. General information

NPI: 1235458282
Provider Name (Legal Business Name): LETA ELIZABETH PLANZ LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LETA ELIZABETH MERCER LSW

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 ROCKY LN
ASHLAND OH
44805-4701
US

IV. Provider business mailing address

2233 ROCKY LN
ASHLAND OH
44805-4701
US

V. Phone/Fax

Practice location:
  • Phone: 419-281-3716
  • Fax: 419-281-4605
Mailing address:
  • Phone: 419-281-3716
  • Fax: 419-281-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0900765
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1303656
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: