Provider Demographics
NPI:1578780581
Name:WILLITS, LESLIE ANNE (CDMS)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANNE
Last Name:WILLITS
Suffix:
Gender:F
Credentials:CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 LAUSANNE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3000
Mailing Address - Country:US
Mailing Address - Phone:937-291-3818
Mailing Address - Fax:937-291-3918
Practice Address - Street 1:5014 LAUSANNE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45458-3000
Practice Address - Country:US
Practice Address - Phone:937-291-3818
Practice Address - Fax:937-291-3918
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator