Healthcare Provider Details

I. General information

NPI: 1295339349
Provider Name (Legal Business Name): LEANNE KECKLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2020
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S US HIGHWAY 23
FOSTORIA OH
44830-9687
US

IV. Provider business mailing address

410 S US HIGHWAY 23
FOSTORIA OH
44830-9687
US

V. Phone/Fax

Practice location:
  • Phone: 419-455-5959
  • Fax:
Mailing address:
  • Phone: 419-455-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: