Provider Demographics
NPI:1336555416
Name:ROLAND, LESLIE J (LISW-S)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:J
Last Name:ROLAND
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 1:234 GOODMAN ST
Mailing Address - Street 2:MAIL LOCATION 0753 ML0753
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-5234
Mailing Address - Fax:513-584-4111
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JAC KSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-2399
Practice Address - Country:US
Practice Address - Phone:253-968-0583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.09003281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical