Provider Demographics
NPI:1407607443
Name:GOODWIN, LEAH RENEE (BSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RENEE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1168
Mailing Address - Country:US
Mailing Address - Phone:419-960-5559
Mailing Address - Fax:
Practice Address - Street 1:201 MADISON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1168
Practice Address - Country:US
Practice Address - Phone:419-960-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker