Provider Demographics
NPI:1699569020
Name:GLOVER, LESLIE R
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:GLOVER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 BABBITT RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2069
Mailing Address - Country:US
Mailing Address - Phone:216-990-6060
Mailing Address - Fax:
Practice Address - Street 1:24865 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2512
Practice Address - Country:US
Practice Address - Phone:440-250-8800
Practice Address - Fax:440-641-1170
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician