Provider Demographics
NPI:1487700399
Name:VIDMAR, LEILA ANN (PCC)
Entity type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:ANN
Last Name:VIDMAR
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7566 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-1725
Mailing Address - Country:US
Mailing Address - Phone:440-289-0639
Mailing Address - Fax:
Practice Address - Street 1:7566 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-1725
Practice Address - Country:US
Practice Address - Phone:440-289-0639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE8092101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor