Provider Demographics
NPI:1285984989
Name:SIMMONS, LESLIE SUE (LMT)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:SUE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2044
Mailing Address - Country:US
Mailing Address - Phone:419-385-0002
Mailing Address - Fax:419-385-8533
Practice Address - Street 1:1833 EASTGATE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3034
Practice Address - Country:US
Practice Address - Phone:419-385-0002
Practice Address - Fax:419-385-8533
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.013144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist