Provider Demographics
NPI:1457570418
Name:MATTES, LEEANN MARIE (LISW)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:MARIE
Last Name:MATTES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6099 RIVERSIDE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2004
Mailing Address - Country:US
Mailing Address - Phone:614-457-0024
Mailing Address - Fax:614-457-0026
Practice Address - Street 1:6099 RIVERSIDE DR
Practice Address - Street 2:STE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2004
Practice Address - Country:US
Practice Address - Phone:614-457-0024
Practice Address - Fax:614-457-0026
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI102411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical