Provider Demographics
NPI:1235458282
Name:PLANZ, LETA ELIZABETH (LISW)
Entity Type:Individual
Prefix:
First Name:LETA
Middle Name:ELIZABETH
Last Name:PLANZ
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LETA
Other - Middle Name:ELIZABETH
Other - Last Name:MERCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2233 ROCKY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-4701
Mailing Address - Country:US
Mailing Address - Phone:419-281-3716
Mailing Address - Fax:419-281-4605
Practice Address - Street 1:2233 ROCKY LN
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4701
Practice Address - Country:US
Practice Address - Phone:419-281-3716
Practice Address - Fax:419-281-4605
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0900765104100000X
OHI.13036561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker