Provider Demographics
NPI:1932310133
Name:ROBERTS, LESLEE YVONNE II
Entity Type:Individual
Prefix:
First Name:LESLEE
Middle Name:YVONNE
Last Name:ROBERTS
Suffix:II
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 1:620 STATE ROUTE 132
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45113-8665
Mailing Address - Country:US
Mailing Address - Phone:513-600-1073
Mailing Address - Fax:
Practice Address - Street 1:7002 STATE ROUTE 350 # 5
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45113-9535
Practice Address - Country:US
Practice Address - Phone:937-289-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4000581670207390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program