Provider Demographics
NPI:1609438605
Name:LEONATTI, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LEONATTI
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 1:15136 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9031
Mailing Address - Country:US
Mailing Address - Phone:440-537-0162
Mailing Address - Fax:
Practice Address - Street 1:695 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1474
Practice Address - Country:US
Practice Address - Phone:440-286-1631
Practice Address - Fax:440-286-1634
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901799101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional