Provider Demographics
NPI:1558027953
Name:STEVENS, LESLIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29055 CLEMENS RD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1135
Mailing Address - Country:US
Mailing Address - Phone:440-425-0155
Mailing Address - Fax:
Practice Address - Street 1:29055 CLEMENS RD STE A
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1135
Practice Address - Country:US
Practice Address - Phone:404-425-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21032261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical