Healthcare Provider Details

I. General information

NPI: 1962079384
Provider Name (Legal Business Name): LESLIE PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 BARDSHAR RD
SANDUSKY OH
44870-1505
US

IV. Provider business mailing address

310 S FRONT ST
FREMONT OH
43420-3086
US

V. Phone/Fax

Practice location:
  • Phone: 740-219-3133
  • Fax:
Mailing address:
  • Phone: 419-552-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: