Provider Demographics
NPI:1396904900
Name:HODGE, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:HODGE
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 1:1333 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5212
Mailing Address - Country:US
Mailing Address - Phone:408-445-3400
Mailing Address - Fax:408-269-1952
Practice Address - Street 1:1118 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4350
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:408-998-8043
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11833FOtherMEDICAL