Provider Demographics
NPI:1467800946
Name:LEGGETT, SONJA
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARROLL
Other - Middle Name:COUNTY
Other - Last Name:TRANSIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2205 COMMERCE DRIVE NW
Mailing Address - Street 2:P.O. BOX 185
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615
Mailing Address - Country:US
Mailing Address - Phone:330-627-1900
Mailing Address - Fax:330-627-1088
Practice Address - Street 1:2205 COMMERCE DRIVE NW
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-0185
Practice Address - Country:US
Practice Address - Phone:330-627-1900
Practice Address - Fax:330-627-1088
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34600519171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH346000519Medicaid