1003021437 NPI number — MRS. DIANA JO LEIGH LISW

Table of content: MRS. DIANA JO LEIGH LISW (NPI 1003021437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003021437 NPI number — MRS. DIANA JO LEIGH LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEIGH
Provider First Name:
DIANA
Provider Middle Name:
JO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003021437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3707 TOWNLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAKER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-283-1946
Provider Business Mailing Address Fax Number:
216-283-1946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24100 CHAGRIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-5535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-292-6520
Provider Business Practice Location Address Fax Number:
216-831-2351
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0003886 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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