Provider Demographics
NPI:1104240795
Name:FRITZ, LESLIE (LISW-S)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:FRITZ
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 NORTHWOODS BLVD
Mailing Address - Street 2:SUITE C1
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4720
Mailing Address - Country:US
Mailing Address - Phone:614-746-9100
Mailing Address - Fax:614-846-1034
Practice Address - Street 1:92 NORTHWOODS BLVD
Practice Address - Street 2:SUITE C1
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4720
Practice Address - Country:US
Practice Address - Phone:614-746-9100
Practice Address - Fax:614-846-1034
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0009401-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical