Provider Demographics
NPI:1801180344
Name:WARTGOW, LESLIE (LPCC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:WARTGOW
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 PRAME AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1626
Mailing Address - Country:US
Mailing Address - Phone:216-651-0360
Mailing Address - Fax:216-651-6491
Practice Address - Street 1:11401 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5428
Practice Address - Country:US
Practice Address - Phone:216-651-0360
Practice Address - Fax:216-651-6491
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0600074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional