Provider Demographics
NPI:1073244786
Name:WASHINGTON, DERLESHIA LACHELL (7611293 IN- PROVIDER)
Entity Type:Individual
Prefix:
First Name:DERLESHIA
Middle Name:LACHELL
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:7611293 IN- PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 19TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-2106
Mailing Address - Country:US
Mailing Address - Phone:330-245-8847
Mailing Address - Fax:
Practice Address - Street 1:1502 19TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2106
Practice Address - Country:US
Practice Address - Phone:330-245-8847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7611293376J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker