MEDICARE: MS. LESLIE D. CLEMENT 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-0007551	OH

General Provider Information

NPI Number	:	1962482455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE D. CLEMENT LISW

Provider Business Mailing Address
First Line	:	13645 LARCHMERE BLVD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-1345
Country	:	US
Telephone Number	:	216-921-1921
Fax Number	:	216-932-3138

Provider Business Practice Location Address
First Line	:	13645 LARCHMERE BLVD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-1345
Country	:	US
Telephone Number	:	216-921-1921
Fax Number	:	216-932-3138

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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