Provider Demographics
NPI:1134672009
Name:LEDGER, LECHANNE RENEE (LSW, LICDC)
Entity Type:Individual
Prefix:
First Name:LECHANNE
Middle Name:RENEE
Last Name:LEDGER
Suffix:
Gender:F
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-3932
Mailing Address - Country:US
Mailing Address - Phone:216-441-0200
Mailing Address - Fax:
Practice Address - Street 1:2675 E 30TH ST
Practice Address - Street 2:O
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3000
Practice Address - Country:US
Practice Address - Phone:216-771-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161009101YA0400X
OHS.1801902104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker