Provider Demographics
NPI:1497346019
Name:BOWER, LILEIGH
Entity Type:Individual
Prefix:MISS
First Name:LILEIGH
Middle Name:
Last Name:BOWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2361
Mailing Address - Country:US
Mailing Address - Phone:567-429-1000
Mailing Address - Fax:419-436-7460
Practice Address - Street 1:125 S MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2361
Practice Address - Country:US
Practice Address - Phone:567-429-1000
Practice Address - Fax:419-436-7460
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2102975-TRNE101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional