Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0003886 | OH |
NPI | 1003021437 |
---|---|
Provider Name | Mrs. Diana Jo Leigh |
First Address | Shaker Heights, OH 44122-5121 |
Second Address | Beachwood, OH 44122-5535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |