Provider Demographics
NPI:1841983285
Name:SMITH, LESLIE (C-CHW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:C-CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18120 PURITAS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-3832
Mailing Address - Country:US
Mailing Address - Phone:216-551-9955
Mailing Address - Fax:
Practice Address - Street 1:18120 PURITAS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-3832
Practice Address - Country:US
Practice Address - Phone:216-551-9955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCHW.002118172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker