Healthcare Provider Details

I. General information

NPI: 1134672009
Provider Name (Legal Business Name): LECHANNE RENEE LEDGER LSW, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 E 30TH ST O
CLEVELAND OH
44115-3000
US

IV. Provider business mailing address

8411 BROADWAY AVE
CLEVELAND OH
44105-3932
US

V. Phone/Fax

Practice location:
  • Phone: 216-771-6460
  • Fax:
Mailing address:
  • Phone: 216-441-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number161009
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1801902
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1801902
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: