Provider Demographics
NPI:1114524733
Name:MUDAHERANWA, LESLIE RUTH (MSW,DDIV, MTH,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RUTH
Last Name:MUDAHERANWA
Suffix:
Gender:F
Credentials:MSW,DDIV, MTH,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-3267
Mailing Address - Country:US
Mailing Address - Phone:559-308-5609
Mailing Address - Fax:
Practice Address - Street 1:3245 W STEWART AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-3267
Practice Address - Country:US
Practice Address - Phone:559-699-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1147281041C0700X
CA972471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty