Healthcare Provider Details

I. General information

NPI: 1932310133
Provider Name (Legal Business Name): LESLEE YVONNE ROBERTS II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 STATE ROUTE 350 # 5
CLARKSVILLE OH
45113-9535
US

IV. Provider business mailing address

620 STATE ROUTE 132
CLARKSVILLE OH
45113-8665
US

V. Phone/Fax

Practice location:
  • Phone: 937-289-3379
  • Fax:
Mailing address:
  • Phone: 513-600-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4000581670207
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: