Provider Demographics
NPI:1639669161
Name:LEITCH, KATHERIN
Entity Type:Individual
Prefix:
First Name:KATHERIN
Middle Name:
Last Name:LEITCH
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 1:14734 BELLEPOINT RD
Mailing Address - Street 2:
Mailing Address - City:OSTRANDER
Mailing Address - State:OH
Mailing Address - Zip Code:43061-9511
Mailing Address - Country:US
Mailing Address - Phone:843-408-3545
Mailing Address - Fax:
Practice Address - Street 1:315 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-1130
Practice Address - Country:US
Practice Address - Phone:330-416-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician