Healthcare Provider Details

I. General information

NPI: 1407361082
Provider Name (Legal Business Name): LESLIE ANN HUFF LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 W RIVER RD N STE 300
ELYRIA OH
44035-2788
US

IV. Provider business mailing address

1706 UTICA AVE
LORAIN OH
44052-3962
US

V. Phone/Fax

Practice location:
  • Phone: 216-835-4188
  • Fax:
Mailing address:
  • Phone: 216-835-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0028367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: