Healthcare Provider Details

I. General information

NPI: 1407770894
Provider Name (Legal Business Name): JEFFERY FLOEHR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFFERY LEITER

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 POLE AVE
LORAIN OH
44052-4303
US

IV. Provider business mailing address

2601 POLE AVE
LORAIN OH
44052-4303
US

V. Phone/Fax

Practice location:
  • Phone: 440-233-2271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00208
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: