MEDICARE: MS. LEONA RADER L.I.S.W.

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-0005566	OH

General Provider Information

NPI Number	:	1629054507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEONA RADER L.I.S.W.

Provider Business Mailing Address
First Line	:	PSC 475, BOX 1661
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 475, BOX 1
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96350
Country	:	US
Telephone Number	:	2538523
Fax Number	:

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/21/2022

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