MEDICARE: LESLIE OPPER LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I-0008963	OH

General Provider Information

NPI Number	:	1174543946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE OPPER LISW

Provider Business Mailing Address
First Line	:	35888 CENTER RIDGE RD
Second Line	:	SUITE 5
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-3086
Country	:	US
Telephone Number	:	440-327-1800
Fax Number	:	440-327-1533

Provider Business Practice Location Address
First Line	:	2525 COLUMBUS AVE
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5500
Country	:	US
Telephone Number	:	440-327-1800
Fax Number	:	440-327-1800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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