Provider Demographics
NPI:1073299509
Name:BRONAUGH, LEAH EARLEEN
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:EARLEEN
Last Name:BRONAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 SYLVANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3925
Mailing Address - Country:US
Mailing Address - Phone:567-202-7424
Mailing Address - Fax:
Practice Address - Street 1:3729 SYLVANWOOD DR
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-3925
Practice Address - Country:US
Practice Address - Phone:567-202-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker