Provider Demographics
NPI:1558107029
Name:LEATHERWOOD, ICSHIA
Entity type:Individual
Prefix:
First Name:ICSHIA
Middle Name:
Last Name:LEATHERWOOD
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 1:7247 RICHMOND DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-3075
Mailing Address - Country:US
Mailing Address - Phone:734-604-2213
Mailing Address - Fax:
Practice Address - Street 1:7247 RICHMOND DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-3075
Practice Address - Country:US
Practice Address - Phone:734-604-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty